From AAHKS 2016
Dr. Brian Cunningham: Hey guys, coming to you live from AAHKS. We have the privilege of grabbing a few minutes of Dr. Jiranek’s time. Current AAKHS President and Chief of Adult Reconstruction of ECU. We’re were talking a little bit ahead of time on the way over here about some of the limitations and challenges with PROs. Give us some insight as to what you think those are.
Dr. William Jiranek: I think PRO’s can’t tell the whole story because I think that lots of things affect somebody’s perception of treatment other than the actual treatments. State of mind, we know that there’s variations from day to day and month to month on PRO’s that may have less to do with the actual condition that’s being treated in the patient’s overall health, so I think PRO’s are very good for general health assessment and then mood, but there also needs to be a provider based analysis or a more objective analysis. Whether it’s from a physician, a therapist, I don’t think we’ll be able to just say, “Hey, how’s your knee replacement?” and say, “Well, their knee replacement is X because this is what the variation said.”
Jiranek: It’s very important, and it’s something we never had before.
Jiranek: I think it’s definitely part of the equation. Then I think there needs to be double input.
Cunningham: Yeah. One of the things that’s been a hot topic multiple presentations that came up multiple times in the business meeting was risk stratification.
Cunningham: How do you get at that with the context of PRO’s, and I think it’s a really tough problem. Do you have any thoughts on kind of where to go for us?
Jiranek: Well, I think the PROs can help you figure out somebody’s attitude towards their risk factor. Of whether they’re willing to change it or not, and so I think they can help you differentiate from that standpoint. I’m not sure how much they can really help if you said, “Okay, this person is obese and they have knee arthritis.” Is their PRO going to be able to differentiate that the reason that they’re not doing well is due to their obesity?
Jiranek: It’s not going to be able to differentiate their risk of having a treatment, I don’t think.
Cunningham: Yeah. It seems like when we need some way to kind of handle the cherry picked lemon drop phenomenon if you will, of finding healthy patients that people want to treat. Then I think a lot of the tertiary centers, you know UCSF when I was a fellow there, they ended up with almost all the complicated patients.
Cunningham: How do you kind of even that out? Do you think we’re going to see some type of a tiering system for reimbursement or…
Jiranek: I think we have to. I think… Uwe Reinhardt is an economist at Princeton has the 80-20 rule.
Cunningham: Oh okay.
Jiranek: That 20 percent of the patients account for 80 percent of our healthcare spent. Those are the people who’re going to get dropped.
Jiranek: We’re going to have to as a society figure out how to take care of them. Because that 20 percent costs three, four, five, even six times what the other percentage does.
Cunningham: Whoa. Yeah, that makes a lot of sense. It’s a tough problem. In the leadership role of this organization, how do you transition from leader to leader? I think that’s one of the interesting things that we deal with a lot, but you’re passing off to [inaudible 00:03:46]
Jiranek: Yeah, so we have a system where you’re in the system for a fair amount of years before you ascend to president, so there’s a third vice president, a second, a first and then a president. You’re working within the system for several years. The average president’s been working in the system for eight or nine years on committees etc. and then moving into the presidential line.
Cunningham: Do you guys kind of earmark an issue as you transition? Like say, you know, we need to really work on risk stratification, or we need to really work on managing CGR.
Jiranek: Oh yeah, we do that. We set priorities. These are things that we think we need to change.
Jiranek: Which is most important? Which is second, which is third? We prioritize and try and work that. I think it’s much better when the organization does that as opposed to each president saying, “Okay, this is going to be my strategy.”
Cunningham: Got it. That makes a lot of sense.
Off screen: I have a question.
Off screen: A question from the audience.
Off screen: What’s your dream scenario with patient-reported outcomes?
Jiranek: That they would be very simplified. That they would be iterative. They would not be a burden for the patient or the provider, and that the data would be collected with that thing that never leaves your left hand. Yes, she’s showing me her iPhone. I think everybody has, particularly in the US, everybody has cellphones. We have to learn how to harness that opposed to sitting somebody down in a chair and giving them a questionnaire and telling them to do it.
Jiranek: Nobody has time for that.
Cunningham: Speaking of time, I think we’re out of it. Dr. Jiranek, thank you very much for giving us a few minutes, appreciate it.
Jiranek: You bet.