The next wave of orthopedic independent practice — Integrative care

Laura Dyrda -   Print  |

Carilion Clinic opened a new $32 million location for its Institute for Orthopaedics and Neurosciences in January. The new 116,000 square-foot building includes 125 patient exam rooms, nine procedure rooms and the capacity for eight diagnostic imaging rooms. But the Institute for Orthopaedics and Neuroscience isn't just a facility; it's a philosophy.

"The Institute for Orthopaedics and Neurosciences is the culmination of the promise of integration in healthcare," says Nancy Howell Agee, president and CEO of Carilion Clinic. "We are creating a care delivery model with multiple disciplines integrated with physicians, nurses, therapists and other clinicians all in one setting surrounding the patient for the best care possible."


The Institute includes locations across southwest Virginia in addition to the new facility to best serve the community. The care approach is standardized across all facility locations.


"There isn't a divergence in protocol or services," says Joseph Moskal, MD, chair of orthopaedics for Carilion Clinic and an orthopedic surgeon with the Institute. "We take a highly collaborative, integrated and interdisciplinary approach with teams of people coming together and interacting about the best plan for the patient. We continue to meet and re-evaluate the protocols, and make changes when necessary. But that isn't done independently in a vacuum. It's collaborative from all the specialties."


The new building facilitates interdisciplinary communication and makes the constant evaluation and information dissemination easy throughout the practice.


"This has been a tremendous way to ensure that clinicians will be collaborative when you put them into settings with one another," says Gary Simonds, MD, chief of neurosurgery for Carilion Clinic and a neurosurgeon with the Institute. "You are rubbing elbows with your colleagues every day at work. We have patients with complex problems and this is an ideal situation for their treatment."


The facility was two-years in the making, transitioning a former grocery story into the medical complex. The initial idea for the new building grew from expanded clinical space to include physical therapy and space for education and research. Developing the new facility required significant resources from all stakeholders.


"It took discipline to follow the plan that included many medical specialties, patient demand, staffing requirements, facility attributes and so forth," says Dr. Moskal. "We coordinated more than 30 user groups that we met with weekly for several months and designed the facility based on their input and patient flow. We included nurses, receptionists, radiology technicians and PAs along with the physicians. It wasn't a top-down process. We created the user group from the bottom-up because we wanted and valued their input."


When the partners agreed on the budget and timeline, they were able to begin the process. But, six weeks into the project, Drs. Moskal and Simonds proposed adding a second floor onto the facility to bring more specialists and opportunities into the single location. They presented their idea to the board of governors and received financial support — as well as the contractor's support — to make the changes.


"We were still able to accomplish the project within the 18 months allotted," says Ms. Agee. "Then we had to coordinate the move when the new building was ready. We planned to close the office on a Friday and move everything over the weekend so we could open again on Monday. But that Thursday we got 24 inches of snow, and the snow changed everything. We went to plan B, moved in at night while continuing to see patients during the day. Forty-eight hours later, we were all moved in, enjoying pizza and the snow."


The team eventually moved to the new location and is now looking forward to the future where their team-based care process will continue to provide value-based and evidence-based outcomes. Cost is also front-of-mind for the Institute and innovating to keep the cost-of-care manageable.


"We want an exceptional experience for our patients and family members when they're visiting," says Dr. Moskal. "It's stressful to be in the situation where you need care, so even the appearance of the Institute is extremely welcoming. We want to be mindful of our financial alignment and achieve efficient processes."


Heading into the future, the new facility allows the Institute to recruit new clinicians and build their team. Physicians are now approaching them asking how to join.


"We are creating a Carilion Clinic brand that can go into other areas for diagnoses and treatment of complex neuromuscular disorders and other types of treatment," says Dr. Moskal.


Carilion also has a burgeoning cardiovascular institute bringing cardiovascular professionals together in a similar manner as the Institute does with orthopedic and neuroscience clinicians.


"We think this is the way of the future," says Ms. Agee. "We will look hard for opportunities that lend themselves to becoming more efficient and effective with high-quality care. We want to reduce the overall cost of care while simultaneously creating a great patient experience. We think we do that already, and our integrative approach just takes us to the next level."


More articles on orthopedics:
Remote orthopedic care: Can it be quality & cost-effective? 5 thinsg to know
AAOS names Dr. Gerald Williams Jr. President: 5 key notes
Dr. Sebastian Herrera joins Mischer Neuroscience Institute & UTHealth

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