In a session titled "Bundling Orthopedics and Other Key Concepts to Improve Orthopedic Volumes," at the Becker's Hospital Review Annual Conference in Chicago, President and CEO of OrthoIndy John Martin, Julie Fleck, RN, COO of Parkview Ortho Hospital and Doug Garland, MD, medical director of Joint Replacement Center at Long Beach Memorial Medical Center, discussed how to have a successful orthopedic department. Barton C. Walker, partner at McGuireWoods, moderated the session.
Mr. Martin discussed the challenges in his market, including sharing data between different electronic medical records platforms, an oversaturated market of orthopedic surgeons and the advent of bundled payments. The OrthoIndy surgeons built a physician-owned orthopedic specialty hospital which they run, and have been able to partner with other local hospitals to share their expertise.
"Within the last two years through our affiliations with hospital partners and through an arrangement with an employer coalition, we were able to move away from our main campus and get into new markets," said Mr. Martin. "We are able to focus on orthopedics and we have arguably the lowest cost of care providers in the Indianapolis market. Our quality is seen as high compared to the competition."
A challenge for Dr. Garland in his California market is receiving reimbursement. California is among the lowest reimbursed states for Blues Plans, according to Dr. Garland, and the workers' compensation system has seen significant reimbursement decline over the past several years. "We make more money on Medicare patients than private payors," said Dr. Garland. As a result, the hospital has spent time and energy promoting efficiencies and cost savings. Dr. Garland devised a three OR, two physician system where two surgeons rotate between three ORs to enhance efficiency. The surgeons also perform minimally invasive procedures and expect patients to be up and moving the same day after surgery.
One of the ways Parkview Ortho Hospital has worked on cost savings is by focusing on overhead expenses. "We had our surgeons at the table with implant representatives," said Ms. Fleck. "We have high and low demand devices and if you are performing something with a high cost, we have perimeters about that. The implant representatives come in and give us pieces and parts, but when it's capitated we tell them they can bring in extra stuff but we're not paying any more."
The panelists also discussed the merits of hospital alignment versus hospital employment. Mr. Martin said when many of his orthopedic surgeons were employed they wanted to be more involved with the decision making process but hospital leaders didn't pay attention to them. "What has gotten our doctors more engaged than anything—more than bundled payments and protocols—is getting them engaged and allowing them to be part of the decision-making."
Mr. Martin discussed the challenges in his market, including sharing data between different electronic medical records platforms, an oversaturated market of orthopedic surgeons and the advent of bundled payments. The OrthoIndy surgeons built a physician-owned orthopedic specialty hospital which they run, and have been able to partner with other local hospitals to share their expertise.
"Within the last two years through our affiliations with hospital partners and through an arrangement with an employer coalition, we were able to move away from our main campus and get into new markets," said Mr. Martin. "We are able to focus on orthopedics and we have arguably the lowest cost of care providers in the Indianapolis market. Our quality is seen as high compared to the competition."
A challenge for Dr. Garland in his California market is receiving reimbursement. California is among the lowest reimbursed states for Blues Plans, according to Dr. Garland, and the workers' compensation system has seen significant reimbursement decline over the past several years. "We make more money on Medicare patients than private payors," said Dr. Garland. As a result, the hospital has spent time and energy promoting efficiencies and cost savings. Dr. Garland devised a three OR, two physician system where two surgeons rotate between three ORs to enhance efficiency. The surgeons also perform minimally invasive procedures and expect patients to be up and moving the same day after surgery.
One of the ways Parkview Ortho Hospital has worked on cost savings is by focusing on overhead expenses. "We had our surgeons at the table with implant representatives," said Ms. Fleck. "We have high and low demand devices and if you are performing something with a high cost, we have perimeters about that. The implant representatives come in and give us pieces and parts, but when it's capitated we tell them they can bring in extra stuff but we're not paying any more."
The panelists also discussed the merits of hospital alignment versus hospital employment. Mr. Martin said when many of his orthopedic surgeons were employed they wanted to be more involved with the decision making process but hospital leaders didn't pay attention to them. "What has gotten our doctors more engaged than anything—more than bundled payments and protocols—is getting them engaged and allowing them to be part of the decision-making."
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