LAUSR

Our healthcare spending is at an all-time high and is projected to consume 19.4% of our gross domestic product by 2027 [1]. As the most commonly performed procedure for Medicare beneficiaries totaling $20 billion in costs [2], total joint arthroplasty (TJA) has come under much scrutiny by federal and private payers. The increased demand for TJA [3] combined with an unsustainable trajectory of spending has triggered a paradigm shift toward valuebased care. Perhaps the most commonly cited formula for value determination is the one introduced by Michael Porter in 2009, wherein value is defined as the ratio of outcomes divided by the costs to achieve those outcomes [2,4,5]. Healthcare economists have proposed that adoption of value-based care will help to improve the economic stability of our system [6]. As demonstrating value takes an increasing role in healthcare reform and reimbursements, there is a challenge to accurately measure value. First, there are no industry-wide accepted metrics to assess outcomes of TJA. Second, determining the costs associated with an episode of care is often tedious, incomplete, and subject to high institutional variability [7]. If orthopedic surgeons are to be compensated based on the value of care, there needs to be a better method to measure it. Our concern is that the value equation defined by Porter [8] is too simplistic to adequately measure value and may underestimate the true impact of a life-changing procedure such as TJA. The following case vignettes better illustrate some of its shortfalls.