Though Hospital for Special Surgery may be physically located in New York City, it has plans to expand its footprint throughout the world in 2017.
HSS is the nation's oldest orthopedic hospital and the No. 1 orthopedic hospital in the U.S., according to U.S. News & World Report's most recent rankings. In November, the hospital announced the launch of its global initiative, which seeks to spread its decades of knowledge and expertise in the musculoskeletal specialty to provider organizations across the world.
Louis Shapiro, HSS' president and CEO, recently spoke with Becker's about the hospital's global strategy, why bigger isn't always better and more.
Note: This conversation was edited for length and clarity.
Question: HSS recently launched an international initiative. Why go global? What does this initiative entail?
Lou Shapiro: HSS has always had a global reputation. Patients…from 80 to 100 countries decide to come here every year for their care.
We also have a global footprint from an education standpoint. People come here from all over the world to learn, and faculty travel all over the world [to teach].
What we realized is we have figured out how to create significant value in our area of specialty. We know how to create leading outcomes for diseases and conditions that fall under the rubric of musculoskeletal health. [Now,] we need to figure out a way to share it with others. It's not at all uncommon — there's rarely a week that goes by where there's not an organization from another country that is interested in talking to us about how to bring the best of HSS to their market. We've always been very cautious about that — we would periodically enter into a business relationship where we help with best practice transfer efforts and work with them to help them get better. We generally call that advisory services.
We decided there was a need for this globally and an opportunity for us to leverage our brand and knowledge in a way that is beneficial to the organization. We decided…to launch it as an organized effort.
Q: Could you go into more detail?
LS: Because of our outcomes, people who want the best care and have ability to travel came here for care. Organizations come to us asking for us to help them get better or to build an HSS in their community or country. We've always been very cautious about doing that. Over the last several years, we've had several relationships where we help with best practice transfer. We've done that in Brazil and in South Korea, for instance.
The Brazil and South Korea relationships are active. We go there and look at how they are providing musculoskeletal healthcare and help them improve their processes and training and education and quality, all things we know how to do here, and help them get better. They also come here and spend time learning with our staff.
Because of what we perceive as something we have to offer and the need that exists in the market, we're going to do that in a more organized effort to bring the best of HSS to the rest of the world, where there's an interested local partner. It will range from advisory, where we're helping them get better, to where they become a center of excellence by achieving a certain level of performance. The most sophisticated relationships will actually create an HSS-like entity in another part of the world, most likely in partnership with [an organization] in that country.
We have several [partnerships] in the pipeline but none at point of completion or announcement.
Q: Healthcare is going through a period of rapid consolidation. Is HSS planning any mergers or acquisitions? If not, how is the hospital going to keep up during this period of change?
LS: The answer is no, we're not planning any mergers or acquisitions.
Toby [Cosgrove, MD, CEO of Cleveland Clinic], who I have the utmost respect for as a healthcare leader, has said there's no question if the insurance industry consolidates, we're going to have to consolidate to negotiate with them.
The essence of HSS' strategy is to be relevant to anyone who is receiving or purchasing services from us. Relevant is a function of the value we provide. If we deliver value —which is the highest quality outcomes with an extraordinary patient experience in a way that is affordable and where the cost is proportional to the quality — then that's our version of scale. So scale may be measured by some in size, and scale for us is measured by value.
Value is not how we get paid. Sometimes the discussion of value gets confused with reimbursement formulas. It's really about what you are providing to patients and whoever is paying the bill or helping pay the cost. And that's why patients will still decide to come here from all over. That's why employers will say, 'We want HSS in our network.' The government is a different story — it's harder to communicate or negotiate with — but it will derive the benefit because of our unique value proposition.
HSS is a large organization with an academic foundation that focuses on one disease or condition category — musculoskeletal health. We do more of that than anyone else in the country, perhaps in the world. As a condition of that, we are very good at that. That's the source, in addition to other things, of the value creation. That's why patients come here, that's why other countries want us to help them get better, and that's how we will stay relevant in a marketplace where unfortunately people believe bigger is better. Bigger may not be bigger, it may just be bigger. Our focus is that better is better. That's the foundation of our strategic plan to navigate through these changing times. It has served us well to date and [I] believe it will help serve us well in the next decade-plus.
Q: I understand HSS has a chief value medical officer position. What brought that about? What role does this C-suiter play?
LS: We have a shorthand way of characterizing our strategic plan: 'Better.' 'Knowledge.' And 'Scale.' So our focus is getting better at what we do regardless of what we have accomplished. As world and industry changes, our view of how to do that is changing. The industry used to measure quality as the absence of complications. I believe that's a low bar — measuring things by absence of bad things happening is an important bar, but a low bar. We really want to get ahead of the curve and look at value, looking at a disease or condition from before you have it to after you receive care; how do we advance the organization to get better at looking at the episodes of care of the diseases we treat.
Catherine MacLean [MD, PhD, HSS' chief value officer], has been a quality executive in a number of environments, including the insurance industry. As part of our 'Better' strategy, we added to our leadership ranks someone who has the ability to help lead us on this value journey. She has a deep expertise in the area. She works with all of our other clinical leaders and support staff on a successful journey in this area.
Q: What makes the role unique as opposed to CMO?
LS: A chief value officer is someone who has a unique expertise to look at our diseases more holistically across an episode of care in a very sophisticated way. Dr. MacLean leads multidisciplinary teams to actually help us take care of that disease or condition better. In the past, if someone comes in and has surgery, you want to make sure that surgery goes well and has no complications. Now we look at the disease more holistically and make sure that's being optimized.
For instance, back pain is a common problem in musculoskeletal care. We know back pain is probably not treated as well as it could be in the country. So Dr. MacLean sits down with other clinical leaders, saying, 'What are our best practices for taking care of patients who have back pain? Do we do that as well as we could; if not, how do we do it better?'
Q: What is your New Year's resolution?
LS: I have one locked down, which is to go to spinning class at least twice a week. The other two are more personal and family-related.
Editor's note: This article was updated to correct the spelling of Catherine MacLean's first name. We regret the error.