Joint replacement program development in the era of healthcare reform
Between 2010 and 2020, the demand for primary joint replacements is expected to increase by 35 percent, according to Sg2. At the same time, the availability of orthopedic surgeons to perform these procedures will decrease, creating an impetus for hospitals to develop programs that will attract the surgeons and patients to the facility. While this may sound like a boon for hospitals that can keep joint replacement surgeons on staff, the government’s increased pressure on healthcare costs, especially for high volume, high cost procedures, could threaten the profitability of these programs.
According to Joe Tomaro, PhD, senior vice president at Accelero Health Partners, a service line consulting firm, the key to success for any joint replacement program post-reform will be focusing on increasing quality while reducing costs. While this may sound fairly straightforward, it can be challenging for hospitals to actually realize this goal.
Jeff Pierson, MD, an orthopedic surgeon with St. Francis Medical Group-Joint Replacement Surgeons in Indianapolis, says the best way to achieve this is through a team-based approach to service line development that includes processes to reduce variability and, thereby, increase quality. While cost reductions are a by-product of this approach, Dr. Pierson says quality is more important in terms of competitive advantage.
Developing care pathways requires a great deal of collaboration between physicians and the hospital. This may seem like extra work to some physicians, but Dr. Pierson says the increase of healthcare consumerism as well as moves by payors to bundle payments is making the need for collaboration almost necessary.
“Patients are coming in with more and more information about a surgeon, the hospital and their report cards,” he says. “Patients are better able to judge quality.” As a result, physicians and hospitals will have to work together to improve outcomes and reduce complications to ensure high scores and keep patients coming in their doors.
7 success factors in service line management
As hospital staff and physicians work together to develop these care processes, they should keep in mind the following seven critical success factors.
1. Reinforce service line infrastructure. Traditionally, hospital services are managed by departments, but the current environment favors a more specialized team-based approach with dedicated teams. “In this model, joint replacement, spine and sports medicine, for example, would be managed by multi-disciplinary dedicated teams, who are educated, equipped with effective management tools and held accountable for improving care, increasing margins and building volumes,” says Bob Hitson, vice president at Accelero.
2. Engage physicians. As Dr. Pierson mentioned, collaboration with physicians is critical to a service line’s success. St. Francis’ joint replacement program holds weekly team meetings and other events to promote a collaborative atmosphere between hospital staff and physicians.
3. Link the care continuum. Outcomes are dependent not only on what happens during surgery, but what happens pre- and post-surgery and into post-acute care. As a result, hospitals must connect all pieces of the care continuum. “In a competitive environment, you can’t just manage the hospital aspect of the care; you need to consider the full care continuum from the surgeon’s office to post-acute services,” says Dr. Tomaro.
4. Balance goals. Goals must be balanced evenly among three areas: quality, financial and volume. The three areas are interdependent, and successful programs effectively balance these three areas of performance, says Dr. Tomaro.
5. Integrate referral sources. Although providing high quality care is ultimately the best way to increase referrals, hospitals should work to integrate referral sources with the facility by involving and educating them on what is differentiating about the care delivered within the service line.
6. Strengthen customer service. While many hospitals have customer service programs in place, they don’t always focus on a service line’s specific areas of weakness, says Dr. Tomaro. Outstanding joint replacement programs have customer service processes in place and education that are specific to the service line and ensure consistent messaging from physicians, nurses and support staff.
7. Build brand strategy. Programs organized under a single service line brand have produced optimal results that distinguish them from a general orthopedic program. Branding and marketing a specific service line makes potential patients aware of the specific services and can drive volume. However, Mr. Hitson notes, “your brand is the care you deliver, and marketing isn’t that useful unless you manage the program well and deliver on the quality and experience promises to the communities you serve.”
Learn more about Accelero Health Partners.
