How 10 hospitals took their total joint replacement programs to the next level

The following 10 hospitals and health systems updated their total joint replacement programs with new initiatives such as data analytics, bundled payments, quality improvement and telehealth. Here are their stories.

Baptist Health System (San Antonio). Global professional services firm Navigant partnered with Baptist Health System in 2012 to develop and implement a program that would fit under the Center for Medicare and Medicaid Innovation's Bundled Payments for Care Improvement initiative. The updates involved redesigning teams and improving the clinical information sharing strategy for better overall care. The program went live in October 2013 for joint replacements, including new initiatives for physician engagement; post-acute network partnerships; gainsharing and funds flow; and supporting analytics. A 2016 case study showed the hospital saved $2.3 million in the first year after participating in BPCI. The hospital also reported a 10 percent reduction in readmissions, 20 percent reduction in skilled nursing utilization and 22 percent reduction in patient rehab utilization.

Hoag Orthopedic Institute (Irvine, Calif.). Hoag Orthopedic Institute participated in the Cambridge, Mass.-based Institute for Healthcare Improvement's Joint Replacement Learning Community in 2014 to gather data and identify areas to maximize value. In 2015, the hospital welcomed a chapter of Avant-garde, which provides hospitals with technology and analytics tools to measure clinical and cost data, to improve scalability and to set standards for care. The next step in the hospital's journey to providing value-based care includes further data analytics for care cycles through the continuum of care. The hospital also was the subject of a Harvard Business School case study examining outcomes, cost reduction and reimbursement. Finally, the hospital has a bundled payment system covering services and participated in the Integrated Healthcare Association's pilot program in 2010 and the National Orthopedic and Spine Alliance program in 2015.

Hospital for Special Surgery (New York City). The adult reconstruction and joint replacement service at Hospital for Special Surgery provides more than 9,000 hip and knee replacements per year and U.S. News & World Report has ranked the hospital as No. 1 in orthopedics for seven consecutive years. The hospital is using telehealth to engage patients before and after their surgeries to improve outcomes and stay connected to the patients after they return home. HSS and ViiMed developed a standardized framework telehealth program for personalized patient education, information and recorded video activities designed to open lines of communication between patients and providers. Among total knee replacement patients, 97 percent report pain relief and 96.3 percent report return to function two years after surgery.

Mercy Medical Center (Des Moines, Iowa). Mercy Medical Center's Joint Camp Program is designed to take a proactive approach to successful recovery and outcomes for total joint patients. The joint camp includes a pain seminar and pre-op classes patients attend with their "coach" — a family member or friend — to learn more about the recovery process. The patient has access to an orthopedic coordinator, care coordinator, physical therapist and pharmacist. The patients also attend joint camp after surgery to practice group exercises and rehabilitation and group therapy sessions are available. Nurse navigators check in with patients after they return home to assess the healing process. The hospital is a Blue Distinction Center+ for Knee and Hip Replacement, as designated by Wellmark Blue Cross and Blue Shield of Iowa.

OrthoIndy Hospital (Indianapolis). The OrthoIndy Hospital includes 15 total joint replacement surgeons who have performed more than 15,000 hip and knee replacement surgeries over the past 10 years. The average length of stay for the total joint replacements at OrthoIndy Hospital is two days or less. The hospital has a five-star overall quality rating from CMS and has genetic testing to identify the best medications for individual patients based on their individual metabolism of pain medications.

Saint Francis Hospital and Medical Center (Hartford, Conn.). The Connecticut Joint Replacement Institute was founded at Saint Francis Hospital and Medical Center in 2007 and was an early adopter of bundled payments, which were a physician-led initiative. Steven Schutzer, MD, is the medical director of the institute and led the charge to develop bundled payments after noticing patients were traveling abroad for elective orthopedic procedures. Dr. Schutzer was among the physicians who partnered with the nonprofit Saint Francis Hospital and Medical Center to negotiate the bundles and track outcomes for quality improvement. The hospital was first to enter data into the American Joint Replacement Registry national database. In May 2015, the institute celebrated its 20,000th knee replacement patient.

Salem (Ore.) Health. Oregon Health & Science University partner Salem Health's Joint Replacement Center of Excellence became the first in Oregon to earn the Joint Commission's Gold Seal of Approval for certification in total hip and knee replacements in 2012. The hospital serves patients who need a more support than an outpatient procedure, but who can still return home after a minimal hospital stay. The hospital created a Track 1 program, which identifies patients who can engage more in their care — those with fewer comorbidities and the support of a family member or friend who can coach them for a week after surgery — for participation. Around 56 percent of the patients at the hospital are Track 1 and 45 percent of those patients discharge one day after surgery. The hospital has also successfully reduced overall length of stay from two nights to one with the Track 1 program.

Sentara Healthcare (Norfolk, Va.). Sentara Healthcare's Sentara OrthoJoint Center has several locations across Virginia and six offer the Express Track where patients agree to specific pre-surgery education and exercises to return home sooner than traditional joint replacement patients. The Express Track patients engage in physical therapy the same day of surgery as well as the next day before returning home. The Express Track patients walk an average of 87 percent further before leaving the hospital than other patients and have a lower readmission rate within 30 days of their initial procedure. A family member serves as a coach for Express Track patients during the entire care process.

South Nassau Communities Hospital (Oceanside, N.Y.). The South Nassau Communities Hospital's Long Island Joint Replacement Institute offers total and partial hip and knee replacements. The surgeons perform total joint replacement with custom-fitted implants using 3-D printed technology and a mobile-bearing knee system. The institute was among the first in the United States to combine image-guided medical technology with minimally invasive knee replacement instrumentation to simplify the procedure with less scarring and faster healing than traditional joint replacements. The program achieved nearly $2 million in savings for the hospital and around $350,000 for the physicians; both shared in the government savings.

UW Health (Madison, Wis.). UW Health's The American Center is the central location for joint replacement surgeries performed by the University of Wisconsin School of Medicine and Public Health orthopedic surgeons. The orthopedic team mapped out and evaluated the patient experience before opening the new facility in 2015to optimize outcomes. Patients undergo the Joints 101 class before surgery, and a patient navigator guides patients through the joint replacement process. The center was the first in Wisconsin to launch TotalCare, an online experience powered by Wellbe that gives patients on-demand video guidance through hip and knee replacement surgery and rehabilitation. UW Health has seen 11 percent to 15 percent shorter lengths of stay for joint replacement surgery, 12 percent fewer discharges to post-acute care facilities and 28 percent to 43 percent fewer readmissions among engaged patients.

Does your hospital's total joint replacement program belong on this list? Becker's Hospital Review will be featuring additional total joint replacement programs in the coming weeks and would like to feature your accomplishments. Contact Laura Dyrda at for more information or with questions or comments on this list.


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