Calvin Lin, president of United Orthopedic Corporation USA, shared his insights with Becker’s Orthopedic and Spine Review on how the company is adapting to bundled payments and the role orthopedic companies can play in supporting evidence-based care.
1. How is United Orthopedic Corporation adapting to bundled payment models for knee and hip replacements?
We believe as bundled payment models are a growing trend in the orthopedic industry, UOC is uniquely positioned to innovate and lead. We are deeply committed to helping providers, payers and patients improve outcomes at lower total costs.
UOC has an inherent understanding of the value proposition evidenced by CMS’ Comprehensive Care for Joint Replacement (CJR). We have invested a great deal in research and quality management systems to deliver products and services that demonstrate value through efficiency, reduction of episode of care costs, and overall improvement to the patient experience.
For example, a significant portion of surgery costs include reprocessing instrument trays, inventory management, training, and preparation time. The average total knee replacement procedure uses six to nine trays and the estimated cost of reprocessing a tray can range from $100 to $300.1 Since 2017, we have successfully reduced the number of trays to 1.5 for every total knee replacement performed with our U2 Knee System and have made the trials disposable. As a result, this has cut hospital costs associated with preparing, storing and reprocessing trays, as well as the training and turn time for OR staff. Eliminating trays also has the potential to reduce the risk of infection. We believe the saved cost and time will allow providers to perform more procedures in the same OR on the same day.
We also offer educational support to surgeons interested in learning about bundled payments. At the recent American Academy of Orthopaedic Surgeons annual meeting, we hosted a lecture by Mark Froimson, M.D., evaluating the keys to success with respect to bundled payments. The presentation emphasized engaging patients and families to optimizing patient preparedness, delivering each procedure efficiently, and engaging the clinical team to utilize best in class clinical protocols. UOC is aligned with Dr. Froimson’s Principles of Care, including patient engagement, support outside of the hospital and elimination of unnecessary resources.
As a vertically integrated orthopedic company, we design and manufacture our products in-house and are able to transfer efficiency and cost-savings to our customers.
2. What role can orthopedic companies play in advancing evidence-based care models?
Evidence-based care models offer providers a way to achieve the "Triple Aim's" objectives – improve the experience of care, improve the health of populations, and reduce healthcare costs, per capita. It is important for orthopedic companies like UOC to play a proactive role in evidence-based care. It all starts with asking customers what their pain points are. By conducting first tier and second tier market and clinical research, we gain insight into how best to address those pain points and come up with a product or service that improves the patient’s outcome or reduces the healthcare cost (ideally both at the same time).
For example, we've observed an increase in demand for rapid recovery total hip replacement using the direct anterior approach. This approach requires a longer learning curve for surgeons who weren’t trained on this technique.2 That’s why we developed our UTS Stem, a bone-preserving shorter hip stem, to ease insertion through smaller incisions and potentially shorten the learning curve.
We noticed one of the top three known reasons for total hip replacements failures is dislocation. Findings from clinical studies demonstrate that a bigger femoral head can reduce the risk of dislocation. To address this, we launched the extension line of our U-Motion II which can accommodate a 36mm femoral head with a 50mm acetabular cup. It provides our surgeons with more options to treat patients with a high risk of dislocation.3
Both products were showcased during American Academy of Orthopaedic Surgeons annual meeting in New Orleans and are anticipated to be commercially available in November 2018.
3. What trends do you see in bundled payment models for orthopedic care?
Bundled payment has incentivized providers and device companies to work together, encourage efficiency, and ensure a level of engaged follow-up care. Studies demonstrate Medicare bundled payments have reduced joint replacement costs by more than 20 percent.4 We believe the bundled payment models are here to stay, so it is our mission to help providers succeed in the world of bundled payment.
References:
1Slamin J, Parsley B. Evolution of customization design for total knee arthroplasty. Current Reviews in Musculoskeletal Medicine. 2012;5(4):290-295. doi:10.1007/s12178-012-9141-z.
2Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of Minimally Invasive Direct Anterior Versus Posterior Total Hip Arthroplasty Based on Inflammation and Muscle Damage Markers. The Journal of Bone and Joint Surgery American volume. 2011;93(15):1392-1398. doi:10.2106/JBJS.J.00557.
3Plate JF, Seyler TM, Stroh DA, Issa K, Akbar M, Mont MA. Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty. BMC Research Notes. 2012;5:553. doi:10.1186/1756-0500-5-553.
4Navathe AS, Troxel AB, Liao JM, et al. Cost of Joint Replacement Using Bundled Payment Models. JAMA Intern Med. 2017;177(2):214–222. doi:10.1001/jamainternmed.2016.8263.