How to keep total joint replacement patients compliant at home to prevent VTE

Practice Management

Venous thromboembolism is a leading cause of hospital readmissions after total joint replacements. But in many cases, VTE is preventable if patients comply with postoperative protocol; they often do at the hospital, but once patients return home it's harder to monitor and ensure they're following the recovery plan.

Avoiding hospital readmissions is always preferable to achieve the best outcomes and reduce costs. However, decreasing readmissions will become even more crucial as providers switch to bundled payments, either under the CMS Comprehensive Care for Joint Replacement model or private payer arrangements.


"Up to this point, there has been a tremendous amount of work done pre-surgery to improve quality and reduce costs, from driving down implant costs to preparing patients for a quick recovery, but now we are really focused on what happens in the 90 days after surgery," says John Krier, vice president of billing solutions for Breg. His company is focused on designing IT solutions and orthopedic devices for patients to use when they return home, and provide education on appropriate use.


DVT initial hospitalizations cost $30,051 and pulmonary embolism costs hospitals $37,006, according to a January 2015 Clinical Therapeutics article. Pharmacological treatment can reduce DVT to 29 percent to 53 percent while intermittent pneumatic compression prophylaxis can reduce DVT risk to 17 percent, according to an August 2000 article in The Bone & Joint Journal.


Data shows complications are more likely after patients return home from the hospital; 50 percent to 75 percent of the hospital readmissions related to VTE occur within 9.7 days of discharge for total knee replacement and within 21.5 days of discharge for total hip replacements, according to a 2012 article published in Orthopedics.


"The patients might do everything right in the hospital and when they are released home their risk of DVT goes up. But we can reduce the DVT risk by up to 75 percent with remarkably easy solutions like the VPULSE which can bring the compression technology to the home," says Mr. Krier. "We also use instructional videos that patients can play on their smart devices or from our website to learn about using the device. We have customer service available to them as well."


The technology provides intermittent compression and continuous cold therapy to address discomfort and reduce DVT. The technology also tracks patient compliance and can share with providers whether the patient is using the technology correctly.


Physical therapy is another crucial aspect of the postoperative period. Many patients return to the hospital, especially after total hip replacement, with stiffness because they weren't compliant with their PT.


"If the patient isn't active with their therapy, they return and might need more surgeries," says Mr. Krier. "Interactive solutions can help these patients stay active and surgeons are looking at new solutions that send information directly to the EMR so they don't lose sight of the patient's recovery."


Breg is focused on providing solutions for the post-surgical portion of the orthopedic episode where there is the most cost variability. In addition to VPULSE, Breg is developing a mobile health platform to help address the cost resulting from a lack of patient compliance with at-home rehabilitation.


"We have to target the major complications and cost areas post-surgically and the procedures we could avoid with our products," says Mr. Krier. "Many companies have looked at treating the issues after the fact, but we need to become more proactive."


The challenges going forward will be matching the data outcomes with the right clinicians and payers. "That will be an opportunity for us in the future; we want to make sure we're tackling the right challenges in the right order," says Mr. Krier.


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