Measuring value at the provider level in the management of cleft lip and palate patients.

"Value" has become a buzzword in current health-care discussions. This study demonstrates a provider-led strategy to measuring costs, an understudied component of the value equation, for a complex diagnosis for the purposes of improvement. A retrospective, microcosting methodology was used to measure costs for all hospital and physician services and costs to the patient over 18 months of multidisciplinary care for patients with cleft lip and palate.

Nasoalveolar molding in cleft care: is it efficacious?

In the era of evidence-based medicine, new treatment protocols and interventions should be routinely evaluated for their efficacy by reviewing the available evidence. In the cleft literature, nasoalveolar molding has garnered attention over the last decade as a new option for improving nasal form and symmetry before primary surgical repair. Systematic review of the evidence is, however, currently lacking.

Patient Protection and Affordable Care Act: implications for pediatric plastic surgery.

Passage of the Patient Protection and Affordable Care Act (PPACA) has stimulated wide debate in the medical and surgical community. Endorsed by the American Medical Association and a number of primary care-focused organizations, the American College of Surgeons (ACS) and nearly all other surgical associations opposed the bill. This divergence stems not from direct disagreement over provisions in the bill but from opposition to or support of certain provisions with direct implications for the physicians represented by a given organization, as well as the relative importance of provisions for which these organizations share a common opinion.

Cost of treating sagittal synostosis in the first year of life.

Background: Endoscopically assisted suturectomy (EAS) has been reported to reduce the morbidity and cost of treating sagittal synostosis when compared with traditional open cranial vault remodeling (CVR) procedures. Whereas the former claim is well substantiated and intuitive, the latter has not been validated by rigorous cost analysis.

Methods: Patient medical records and financial database reports were culled retrospectively to determine the total cost associated with both EAS and CVR during 1 year of care.

Cost differences between the anterior and posterior approaches to the iliac crest for alveolar bone grafting in patients with cleft lip/palate.

Purpose: There has been debate in the literature regarding the advantages of an anterior versus posterior approach to the iliac crest harvest for alveolar bone grafting (ABG) in patients with cleft lip and palate. The purpose of this study was to add a cost perspective to the discussion.

Materials And Methods: This was a retrospective microcost analysis for the perioperative period for 2 approaches to graft harvest for ABG in patients with cleft lip and palate.

Timeliness of surgical care in children with special health care needs: delayed palate repair for publicly insured and minority children with cleft palate.

Background/purpose: Disparities in access to health care are known to exist for the most vulnerable pediatric population, children with special health care needs. Timely access to surgical care in this population is critical, yet poorly studied.

Methods: A national database of pediatric hospitals in the United States was searched for nonsyndromic, healthy patients younger than 24 months who underwent cleft palate repair from 2003 to 2008.

The value proposition: using a cost improvement map to improve value for patients with nonsyndromic, isolated cleft palate.

Background: As health care costs rise exponentially in the United States, increasing emphasis is being placed on measuring value, which incorporates both quality and costs. Although the concept of continuous quality improvement has taken a firm foothold in health care, techniques for measuring and continuously improving costs at the patient or system level are lacking.

Methods: A retrospective, microcosting analysis mapped detailed medical costs over 18 months for 25 patients with nonsyndromic, isolated cleft palate to illustrate the concept of a continuous cost improvement map in a complex, multidisciplinary condition.

A microcosting approach for isolated, unilateral cleft lip care in the first year of life.

Background: The concept of value-based health care underlies many new improvement initiatives in U.S. health care.

Marginal zone B-cell lymphoma of the infratemporal fossa: a rare case and review.

Although it represents the second most common neoplasm of the head and neck, lymphoma is generally not surgically managed and thus may be less familiar to otolaryngologists than other malignancies. However, otolaryngologists are often involved in the initial diagnosis, and should be aware of unusual presentations and the main lymphoma subtypes. We present a case of an extranodal marginal zone B-cell lymphoma, an indolent non-Hodgkin's lymphoma subtype.

Value-based cleft lip-cleft palate care: a progress report.

Background: The health care debate in the United States centers on a concept that is fundamental to any service-based profession yet minimally integrated into the health care community: value creation. Value in health care has been defined as outcome achieved per dollar spent, and focuses on the patient. Many of the new strategies proposed to restructure health care delivery in the United States aim to study and improve both components of this equation.