SwiftPath: Putting the surgeon at the helm


These days, you can't turn on the TV or read the paper without hearing healthcare and the cost of healthcare being more than just a political issue — it has become a crisis for the country. Orthopedics, in particular, joint replacements have become a focus of the federal government. Joint replacements are putting unsustainable pressures on an already stressed system, and that is leading a number of forecasters and analysts to suggest that one of the fundamental ways to begin bending the cost curve is to shift joints to a lower cost outpatient environment.


If this migration occurs at even a fraction of what people are anticipating, we will need a different way of thinking around how we approach the joint replacement surgical episode. This kind of a paradigm shift does not come in a vacuum, it requires re-visiting a lot of the assumptions made by clinicians and the surgeons. And there's nobody better suited, and better qualified, to lead that charge.

To lead, surgeons will have to rethink the litany of decisions they are making. Preoperatively, intraoperatively and postoperatively, there are a number of steps that have to be done in a differentiated way — not incremental and differentiated, but transformatively differentiated.


That process in and of itself will require a greater degree of collaboration, because nobody will discover some monopolistic truths in the corner. One of the wonderful things about medicine and the clinical world is that they promote generally a collaborative environment, where discoveries are shared and iterative processes lead us toward better care. This is where the SwiftPath RoundTables have been key. Physicians sitting around, collecting data, sharing the data, modeling different things, deploying adjustments to the processes and then re-collecting data is what will be required for a truly transformative shift in care for the joints.

Patient engagement has become central to the process. Once the patient is effectively engaged, it helps their recovery. Because they take ownership, patients are not passive recipients of care, but they are now partners in their own outcome. That has positive impact on the patient's experience, and satisfaction postoperatively. In the SwiftPath curriculum, patient expectations are clearly defined. Patients expect a certain amount of pain. In historical models, expectations were not effectively managed. Patients were allowed to create their own set of assumptions, and those assumptions were confronted when reality was different and they were dissatisfied.


We have to start looking just beyond comorbidities. The patient's environment, support, comprehension and attitudes about their care impact the speed of their recovery. Just as importantly, aftercare and how surgeons stay linked with a patient postoperatively will greatly influence the quality of the outcome — whether it's pain-level, function, nausea, sleep, return back to life and work. The patient needs to be an active communicator without the clinician watching them 24/7.


As we transition to outpatient joint replacements, there will be two key stakeholders who will define quality. One is the payers who take on risk; they measure the quality through the prism of cost. Complications, re-operations, admissions to ER, re-admissions to the hospital postoperatively will be in the crosshairs. Currently, there are no established methods, processes, or criteria, to collect and benchmark. The most important stakeholder is the patient. Patients care about pain, functionality, and return to work or normal life, and long-term function. Regardless how much money is saved, and how quickly some patients recover, if you're risking patients' lives in the process then you have lost the battle.


Presently, there is no consensus on precisely how to measure quality. Unless the physicians step in, take leadership and begin defining the true benchmarks, somebody else will enter that vacuum. And that somebody will not be as qualified as a surgeon.


There are a lot of these kinds of efforts occurring in pockets across the country. Physicians are duplicating each other's efforts and are not creating a forum where they can incrementally learn from each other. SwiftPath is the forum for that. The beauty of SwiftPath is that it produces superior clinical results. Rather than having folks individually try to sort this out on their own, which is a lot more risky, it's better to include them in the SwiftPath RoundTables, where they can get up to the learning curve much faster.


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