Brett Gosney: 4 Ways to Improve Your Hospital-Based Orthopedics Program

Orthopedics can be a profitable service line for your hospital due to good reimbursement and increased demand for orthopedic surgeries. With a few adjustments, hospitals can move their orthopedics lines from good to exceptional.

Brett Gosney, CEO of Animas Surgical Hospital in Durango, Colo., shares four ways in which you can improve the orthopedics program at your hospital.

Brett Gosney1. Decrease surgeons' "down time" between cases. Efficiency in your operating room is one of the best ways to see profitability and surgeon satisfaction increase in your orthopedics department. An important step in this process is to decrease the amount of time it takes to turn over an OR between surgeries, according to Mr. Gosney.

"Some of our orthopedic surgeons came to us from other hospitals and said they would have 45-60 minutes waits between cases. Since working in a hospital with efficiency models, they say they have gained a day a week in their lives, which they can use to spend time with their families or to bring in more cases," Mr. Gosney says.

Hospitals should aim to have a 10-15 minute turnover time between cases. The key to this is to have trained OR staff that concentrates in orthopedics only. Coordination and communication between staff members is important as well. "We like to schedule our bigger cases earlier and group cases by type, such as shoulders and knees. These are tricks of the trade that are learned through experience," Mr. Gosney says.

2. Stay on schedule. An important step to decreasing turnover time is to start ORs on time and to coordinate care so that they can stay that way throughout the day, according to Mr. Gosney. This builds upon a "focused factory" model that concentrates on doing one specialty well.

Mr. Gosney suggests bringing patients into anesthesia on a tight schedule so that they are ready to go as soon as the OR opens. "It all starts with the culture," he says. "We started as an ambulatory surgery center before becoming a surgical specialty hospital, and we have tried to become customer-service oriented, and keeping on schedule is a big part of recognizing our customers and their time."

Keeping on schedule will not only improve patient satisfaction, but it can cut down on staffing costs at the hospital. "If your OR can close at 4 p.m. rather than 7:30, you will save money on staffing and your employees will be pleased that they can have a defined schedule," Mr. Gosney says.

3. Offer services that fit your demographics. Considering the needs of patients in your area is crucial to a successful orthopedics service line, according to Mr. Gosney. Once your hospital determines what the patients it serves need, then you should recruit physicians accordingly.

"Hospitals in big, urban markets may benefit from more niche practices, such as physicians who specialize only in sports medicine or total joint replacement," Mr. Gosney says. "In a small- to medium-sized market, hospitals may need to recruit orthopedic physicians who have a mix of skills."

Mr. Gosney says researching and gauging the activity level of people in your surrounding community can be helpful in determining what services to offer and hiring the right physicians with the correct skill sets to help.

"In Durango, where my hospital is located, we have a very sports-oriented community and a lot of active retirees," he says. "To respond to this, we brought in two fellowship-trained physicians from The Steadman Clinic. We also brought in a physician that specializes solely on total joint replacement with focus on this 50-80 year-old, active population."

4. Standardize surgical equipment when possible. Consideration for physician preference is important; however, hospitals can often lose money in supplying different equipment for each individual surgeon. A key to maximizing revenue in this area is standardization, according to Mr. Gosney.

"Standardization can extend to all equipment at your hospital, especially on commonly used items such as shavers, burrs, screws and plates," Mr. Gosney says. "Capital equipment should also be standardized, because it doesn't make sense to have one surgeon using OR equipment by Stryker and another to use DePuy. It would be too expensive."

Physicians should be involved in all decisions related to standardizing equipment, according to Mr. Gosney. "You want to show surgeons that you value their opinions, especially as they are the ones using the equipment," he says. "At our hospital, we ask the surgeons what systems and equipment they are interested in, and then the administration works with the OR and materials managers to bring in samples and trials so that we can see which systems will provide the best quality for the price."

The final step in this process should be to follow-up with surgeons and gauge their opinions before making the decision on which vendor to use.

Mr. Gosney is the CEO of Animas Surgical Hospital in Durango, Colo., and president of Physician Hospitals of America. Learn more about Animas Surgical Hospital at

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