Transparency in healthcare can work today — Hoag Orthopedic Institute proves it

Practice Management

Hoag Orthopedic Institute, a physician-owned joint venture orthopedic specialty hospital, has been at the forefront of transparency in healthcare for several years and a model for other healthcare institutions according to an article Ezekiel Emmanuel, MD, penned for Fortune Magazine.

The hospital has posted quality data on its website for the past three years and publishes a 45-page book annually on outcomes, including charts, graphs and operations data. The data includes:


• Readmission rates
• Surgical site infections
• Complications
• Pain relief
• Functionality/return to activity


The hospital also includes quality improvement projects in their reports and efforts to reduce infections.


Hoag Orthopedic Institute also provides cost data for self-pay patients including the facility fee, surgeon's fee, implant cost, anesthesiology, overnight stays and surgical assistant. Rehabilitation isn't included in the price, as many patients travel for surgery and then receive rehabilitation back home. The prices are:


• Total hip replacement: $20,250
• Partial knee replacement: $20,250
• Spinal fusion: $38,000


The hospital reported 40 percent of its patients were Medicare patients last year and Hoag is on track to provide more than $2 million in charitable care this year. Here are four key ways Hoag has been successful:


1. The physician-owned facility is a joint venture with a not-for-profit community hospital and cares for the underserved population as well as offering financial help for surgery.


2. HOI is a "focused factory" for orthopedics, an elective surgery with the potential to improve patient health and reduce costs.


3. The hospital doesn't advertise beyond the quality reports every year.


4. The hospital partners will compete on quality and price, collecting data on quality, cost and patient satisfaction. They conduct time motion studies to determine true costs and inefficiencies to eliminate.


"Hoag shows that transparency on price and quality in medicine is not spine surgery," wrote Dr. Emanuel. "It can be done, not tomorrow or by the end of the decade, but today, if only physician leaders had the courage to put all their data up on the web."


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