outpatient total joints in the asc
TRANSCRIPT
Webinar: Outpatient Total Joints in the ASC
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Curt [email protected]
Kim JablonskiTotal Joint Program [email protected]
Aaron BleierFinance [email protected]
Orthopedic & Sports Institute of the Fox Valley
Curt [email protected]
Discussion of Timelines, Research, Recovery Inn
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Innovation Timeline
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Implementation Timeline
2008 — First partial knee replacement surgery; converted recovery area into “hotel suite” for 23 hour stay
2009 — First total knee and total hip replacement surgeries, followed by total shoulders and ankle
2010 — Opened onsite Skilled Nursing Facility (Recovery Inn)
2011 — Knee and hip volumes increase; first bilateral total knee replacement surgery
2012 — Spine cases at ASC
2013 — Spine fusion including observation at attached SNF
2014 — Increased volumes of total joints and spine case complexity
2015 — Bundle price contracting direct to payers and self-insured employers
2016 — First anterior/posterior lumbar interbody fusion procedure at ASC
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Research
Chicago, IL - Rush University Medical CenterManitowoc, WI – Manitowoc Surgery CenterOrange County, CA – Orthopedic Surgery CenterSioux Falls, SD – Alvine Clinic & Surgery CenterSpokane, WA – Northwest Orthopaedic SpecialistsNew Haven, CT – Yale - New Haven Hospital
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Recovery Inn
Attached Skilled Nursing Facility with 12 hotel-inspired healing suites, onsite medical director, physical & occupational therapy, and restaurant
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Orthopedic & Sports Institute of the Fox Valley
Kim JablonskiTotal Joint Program [email protected]
Discussion of Program Success Factors, Education, Metrics
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Key Success Factors (Process)
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• Patient Screening: Orthopedic, Anesthesia, Primary Care• Upon initial screening approval: Dental clearance• Financial review of insurance• Weekly Total Joint Meetings (continual improvement)• Transfer Agreements w/ hospital• Protocols: Pain Management (Pain Out)• Access to Blood Bank & Lab
The total joint process was designed from a clean slate to address cost, current technology, medical capabilities, facilities, and patient needs. Every step of our process keeps patient safety at the forefront.
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Key Success Factors (People)
• Total Joint Program Director • Anesthesia & Pain Management• Surgery Center Clinical Director & Quality Manager• Home Health Care Provider• Skilled Nursing Provider• Surgeon Education (Patient Expectation Setting)• Physical Therapy (Pre-Op Evaluation & Post-Op Care)• Iterative learning process based upon weekly meetings and
feedback loop involving all entities
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The process was designed to create a single owner for each functional area as well as allow for patient care collaboration.
Staff Education
• MDs must be confident in presentation to potential patients –patients take physician lead
• Total Joint Program Director to ensure patient education and completely scripted process from time of scheduling to discharge planning. Contingency planning for blood, labs, etc.
• Physical Therapy – protocols established including timing of all therapy
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Progression of Education
Education format for outpatient total joints:
• Folder with handouts and one-on-one session led by Total Joint Program Director
• Joint Venture – proprietary program management software
• Personalized three-ring binder and one-on-one education session led by Total Joint Program Director
• Wellbe - Interactive & patient-driven online education tool
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Wellbe
Connected NavigationMonitoring Adherence and Deviations in Care Plan
Back-on-track
Intervention Automated, Scalable, Cost-Effective
Available on iPad, SmartPhone &any Web Browser
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Benefits of Wellbe
Wellbe vs traditional education format:
• Patients get information they need when they need it
• Caregiver has the ability to participate on the patient’s behalf if needed
• Provides a more collaborative and efficient patient experience
• Provides for an easy method of collecting and submitting important survey data
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Metrics
Program Metrics Tracked:
• Infections
• ER Visits
• Readmits
• Falls
• Pain Management
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Emergency Department – After Discharge
• Cellulitis
• Nausea, vomiting, diarrhea, dehydration
• Uncontrolled pain/swelling
• Constipation/ileus
• Pneumonia
• Complications related to fall
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Emergency Department – Transfers
• New onset atrial fibrillation
• Respiratory failure/exacerbation of COPD
• Vasovagal/chest pain
• Constipation/ileus
• Pulmonary embolism
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Hospital Readmissions
• Infections
• Respiratory failure
• PE/DVT
• Constipation/ileus
• Dysrythmias
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Orthopedic & Sports Institute of the Fox Valley
Aaron BleierFinance [email protected]
Discussion of Business Issues, Volumes, Payers, Bundled Payments/Direct Contracting
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Business Issues
• Developing rates and contracting with payers
• Collecting patient EOB’s• Activity based costing analysis
• Negotiating rates with implant vendors
• Facility modifications to accommodate overnight patient stays and sterile processing requirements
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Total Joint Volumes
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Total Joint Replacement Payers
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Bundled Payments/Direct Contracting
Bundled Payment:
A single payment based on expected costs for an entire episode of care.
Direct Contracting:
An arrangement between a provider and an employer to deliver medical services at an agreed upon rate.
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• Ability to control a high cost medical item (orthopedic surgery) by 30%
• Provide a lower cost solution for employers trying to control their medical spend
• Improve employee satisfaction based upon faster and safer return to lifestyle
• Develop a strategic relationship with medical providers that will continue to improve results
• Direct employee consumerism to Centers of Value
Benefits of Bundled Payments for Employers
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Benefits of Bundled Payments for Employees
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NOVO Health represents board-certified, independent physicians that offer specialty healthcare solutions to self-insured companies that save money, improve the quality of medical outcomes, and provide unmatched patient experience. For more information on NOVO Health providers and Directing Contracting, download our white paper @ novohealth.com.
Curt Kubiak, CEO & Co-Founder920.209.7377; [email protected]
Bob Zuleger, VP – Business Development920.851.0221; [email protected]
Patti SchaetzVP – Employer Relations920.470.5133; [email protected]
Tony EngedalVP – Strategic Accounts920.979.7761; [email protected]
NOVO Health
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Streamlining Orthopedic Patient Pathways
www.wellbe.me