Published 2/1/2009
Toya M. Sledd, MPH, MBA

Transforming America’s healthcare system

National Priorities Partnership targets key areas for change

The United States currently spends twice per capita what other major industrialized countries spend on health care, and costs continue to rise faster than income. But politicians and media are quick to point out that this spending does not translate to results. U.S. performance on measures of health system efficiency remains especially low, scoring 53 out of 100 on measures gauging inappropriate, wasteful, or fragmented care; avoidable hospitalizations; variation in quality and costs; administrative costs; and use of information technology.

On Nov. 17, 2008, the National Priorities Partnership (NPP), convened by the National Quality Forum (NQF), announced its agenda to help transform the nation’s healthcare system. The NPP—28 national organizations representing the full gamut of health care—hopes to achieve real healthcare reform in the next 5 years through a series of national priorities and goals. If implemented broadly, the NPP goals would reduce harm, improve patient-centered care, eliminate healthcare disparities, and remove waste from the system.

Six priorities for reform
The NPP identified the following six priorities to target reform:

  • Patient and family engagement—Engaging patients and families in managing their health and making decisions about their care
  • Population health—Improving the health of the population
  • Safety—Improving the safety and reliability of America’s healthcare system
  • Care coordination—Ensuring patients receive well-coordinated care within and across all healthcare organizations, settings, and levels of care
  • Palliative care—Guaranteeing appropriate and compassionate care for patients with life-limiting illnesses
  • Overuse—Eliminating overuse while ensuring the delivery of appropriate care

Under the Overuse priority, the NPP recommended the following specific areas of concentration relevant to orthopaedic surgeons:

  • Unwarranted procedures, targeting spine surgery,
  • knee replacement, and hip replacement
  • Unwarranted diagnostic procedures, targeting bone or joint X-ray prior to conservative therapy, without red flags, and lumbar spine magnetic resonance imaging prior to conservative therapy, without red flags

The NPP emphasized that, for these and other identified target areas, these tests and procedures are absolutely appropriate and necessary for some patients. Studies have been conducted, investigating overutilization in knee and hip replacements. According to an Outcome Studies in Orthopaedics, underuse of orthopaedic procedures is more of an issue than overuse. Orthopaedic surgeons have a duty to ensure that the appropriate processes and standards are in place to avoid overuse, misuse, and underuse of tests and procedures to diagnose and treat musculoskeletal conditions and ensure that patients are receiving appropriate treatment and care.

Changing the delivery of care
About a third of every dollar Americans spend on healthcare (an estimated $600 billion to $700 billion annually) is spent on unnecessary and even unsafe care. Inappropriate use, misuse, or overuse of medical interventions pose many serious threats to the population. Beyond the negative impact of wasted resources that people cannot afford, the inappropriate use of health care may cause unnecessary harm to millions of Americans.

To improve results, the ways in which care is delivered must change, says the NPP. This will require a collaborative effort by patients, healthcare organizations, healthcare professionals, community members, payors, suppliers, government organizations, and other stakeholders. Janet M. Corrigan, PhD, president and CEO of the NQF affirmed, “We have an urgent need to fix health care and must have a common vision to succeed. The NPP is aligning resources and actions to focus on reform in the areas where change can make the biggest impact.”

“To support the NPP, the Physician Consortium for Performance Improvement (PCPI) will develop measures in areas that the NPP [has] identified as priorities, such as care coordination, patient safety, and overuse,” said Bernard Rosof, MD, MACP, PCPI chair.

As a PCPI member, AAOS will continue to work closely with PCPI and its membership in developing performance measures. According to Robert H. Haralson, III, MD, MBA, the AAOS medical director and chair of the NQF’s Health Professionals Council, “The National Priorities Partnership is important to the work that we do and we should begin to develop our evidence-based guidelines and performance measures around these priorities.”

Toya M. Sledd, MPH, MBA, is the clinical quality improvement coordinator in the AAOS department of medical affairs. She can be reached at sledd@aaos.org

The National Priorities Partnership
The following organizations are part of the National Priorities Partnership (NPP). The AAOS contributes to the NPP through its membership in organizations marked with an asterisk:

Agency for Healthcare Research and Quality
Alliance for Pediatric Quality
America’s Health Insurance Plans
American Board of Medical Specialties *
American Nurses Association
Ambulatory Care Quality Alliance *
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Certification Commission for Healthcare Information Technology
Consumers Union
Hospital Quality Alliance
Institute for Healthcare Improvement
Institute of Medicine
Leapfrog Group
National Association of Community Health Centers
National Business Group on Health
National Committee for Quality Assurance *
National Governors Association
National Institutes of Health
National Partnership for Women & Families
National Quality Forum *
Pacific Business Group on Health
Physician Consortium for Performance Improvement *
Quality Alliance Steering Committee
The Joint Commission
U.S. Chamber of Commerce


  1. The Commonwealth Fund, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008, New York: Commonwealth Fund; 2006. Available at www.commonwealthfund.org/usr_doc. Last accessed December 2008.
  2. IOM, National Academy of Engineering, Building a Better Delivery System: A New Engineering/Health Care Partnership, Washington, DC: National Academies Press; 2005.
  3. National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008. Available at http://nationalprioritiespartnership.org/8-256. Last Accessed December 2008.