The following 10 hospitals and health systems improved their total joint replacement programs through participating in alternative payment initiatives, aligning physicians and staff and using data analytics to realize better quality and cost savings.
Becker's Hospital Review published the list "How 10 hospitals took their joint replacement programs to the next level" in September. Here are 10 more, selected based on nominations and editorial research:
Augusta Health (Fishersville, Va.). Augusta Health partnered with Stryker Performance Solutions in 2013 to implement a Destination Center of Superior Performance for Total Joint Replacement. The hospital used the proprietary Marshall | Steele 4 A's Methodology to bring together staff and physicians around benchmarking service lines; creating goals; implementing new processes and protocols; and reporting clinical, operational and patient performance data. Three years after beginning the program, 76 percent of the patients were able to walk more than 300 feet before discharge; prior to the program, only 10 percent of patients reached that goal. The hospital was able to reduce blood transfusions by 84 percent which led to $324,000 in savings since the program began. The hospital also reduced length of stay to just over two days, saving $323,000 since 2013. The total direct cost per case dropped 14 percent from 2013 to 2016.
Euclid (Ohio) Hospital. Euclid Hospital, a Cleveland Clinic hospital, participated in the Bundled Payments for Care Improvement initiative, treating 271 patients hipe and knee replacement patients in the first year. The hospital promoted physician engagement and established a specialty care coordinator to manage the joint replacement patients. One year after the program began, the hospital reported average length of stay dropped to 2.4 days from between 2.67 and 3.01 days. The 30-day readmission rates decreased from 5 percent to between 1.6 percent and 2.7 percent for each quarter after program implementation. The percentage of patients discharged home with and without home healthcare increased from 39 percent to a quarterly range of 68 percent to 75 percent. The hospital realized a financial value creation of $522,389 across all episodes of care.
Herrin (Ill.) Hospital. Carbondale, Ill.-based Southern Illinois Healthcare's Herrin Hospital supports an all-inclusive joint replacement surgery program that includes an alliance with the Rehabilitation Institute of Chicago. The hospital has experienced success with its Joint Camp Program and hired an orthopedic coordinator. Since then, the hospital saw improvement in length of stay, readmission rates and pain management after surgery. Herrin Hospital has certification in hip and knee replacements from The Joint Commission.
Johns Hopkins Bayview Medical Center (Baltimore). Johns Hopkins Bayview Medical Center has developed a total joint program focused on improving patient care in both quality and safety, improving efficiencies in an academic setting and decreasing variability around safety and costs. The program includes a robust preoperative screening process, dedicated joint replacement team, multimodal pain control, zero catheter and drain usage and tranexamic acid usage to promote a decrease in transfusion rates. Since its inception in 2013, program outcomes comparing 2013 to 2015 are notable for a 56 percent reduction in length of stay, 33 percent reduction in 30-day readmission rates, 40 percent reduction in transfusion rates and 70 percent of all joint patients discharge directly home. HCAHPS scores continue above benchmark for hip and knee pain management. JHBMC in one of only four hospitals in the country that participates in the Employer Centers of Excellence Network from Pacific Business Group on Health, which assists in negotiating bundled payments for self-insured employers, for total hip and total knee arthroplasty.
Providence Health & Services (Renton, Wash.). Surgeons at Providence Health & Services, which includes hospitals in five states, perform more than 21,000 joint replacements each year. The health system built its own internal registry and works with clinicians at each location to develop a patient-reported outcomes tool so clinicians working in multiple practice locations could use the same level of aggregated data. The health system also gathers cost information and adds their data to the analytics from the Comprehensive Care for Joint Replacement claims to project a stronger picture of the total joint patient episodes of care. This initiative created alignment between the clinicians and outcomes improvement efforts. For example, the hospital identified the strong and weak performers for readmissions and examined the patient selection criteria at the strong sites. Then the information was spread throughout the hospitals in the system to reduce readmissions in the poor performing sites. The health system is also transparent with surgeons about their costs and is seeing movement toward standardized implants and approaches to care.
PinnacleHealth System (Harrisburg, Pa.). Surgeons at PinnacleHealth System perform around 1,600 knee replacements and 1,000 hip replacements annually. The system's Bone and Joint Institute opened in 2012 to enhance the patient experience, reduce cost and improve clinical outcomes. Twenty orthopedic surgeons from three independent orthopedic practices collaborated with PinnacleHealth System to open the institute. The institute includes a perioperative optimization program to identify patients at high risk for postoperative complications and manages them accordingly. Since implementing the program, the hospital reduced the average length of stay by two days, and many patients are discharged one day after surgery. Only 8.7 percent of joint replacement patients discharge to skilled nursing facilities and 5.9 percent to acute rehab facilities. The system realized a $6.5 million reduction in overall costs associated with hip and knee replacements.
Sacred Heart Medical Center (Springfield, Ore.). PeaceHealth's Sacred Heart Medical Center updated its joint replacement program with the Back On Track program in 2012. The program now includes femoral nerve blocks, group exercise classes, an individual physical session each day after surgery and discharge from the hospital on within two days of surgery for many patients. Surgeons perform more than 1,200 knee and hip replacement procedures at the hospital annually and after implementing the program in 2012, the hospital saw the length of stay drop 20.3 percent for knee replacements and 21.45 percent for primary hip replacement patients.
Santa Rosa (Calif.) Memorial Hospital. Irvine, Calif.-based St. Joseph Health System's Santa Rosa Memorial Hospital set out to become a an Intralign Health Total Joint Arthroplasty Center of Excellence in 2014 to combat increased competition for patients, concern over operational changes and cost pressures across the episode of care. The hospital partnered with Intralign Health to lead the Center of Excellence initiative and navigate healthcare reform programs such as Comprehensive Care for Joint Replacement. By the third quarter of 2015, the hospital realized a surgical volume increase and around $1.5 million in savings. An additional initiative included optimizing the OR and block plan schedules, which resulted in 213 more block hours and 315 hours of urgent/emergent and service-line block per month.
St. Vincent's HealthCare (Jacksonville, Fla.). This nonprofit health system partnered with Stryker Performance Solutions in 2012 to prepare for the Bundled Payments for Care Improvement initiative. The hospital previously partnered with Stryker on physician alignment through orthopedic co-management and population health initiatives through the formation of an ACO. St. Vincent's HealthCare created a lower extremity joint replacement bundle at its Riverside Medical Center and Southside Medical Center, both in Jacksonville, Fla., on Jan. 1, 2014, and since then the health system has realized $3.89 million in cost savings. Riverside decreased the average episode cost by more than 15 percent and Southside decreased the average episode cost by 20 percent.
Virtua Joint Replacement Institute (Voorhees, N.J.). The Virtua Joint Replacement Institute in Southern New Jersey specializes in minimally invasive, quad-sparing total knee replacement surgery and hip replacement. The JRI operates with a rapid recovery model; patients are able to walk within a few hours of their surgery and most are discharged the next morning. Of the 90 percent of patients discharged home, 60 percent go directly to outpatient physical therapy. All patients work with a clinical nurse navigator to guide the patient through the pre- and postoperative periods. The Virtua JRI entered into CMS' Bundled Payments for Care Improvement initiative and achieved $4.6 million savings in the first year. Since it opened in August 2012, the JRI has been ranked in the 99th percentile in a patient satisfaction rating, according to the HCAHPS national survey.
Please contact Laura Dyrda with any questions or comments on this list at ldyrda@beckershealthcare.com