'The future is here now': 5 physicians on orthopedics & patient-centered care

Written by Angie Stewart | July 20, 2018 | Print  |

Five physicians affiliated with Denver-based Muve Health shared their predictions on what the future holds for orthopedics and patient-centric care.

Note: Responses have been lightly edited for length and style.

R. Michael Meneghini, MD, Indiana University Health Hip & Knee Center (Fishers). "There is little doubt a transition from fee-for-service to value-based care with occur over the next five years, as well as a transition from inpatient services to the outpatient setting for procedures like total hip and knee replacement. The value must involve not only decrease in cost, but an increase in quality. It is clear the cost reduction will involve the post-acute care after surgery within the 90-day episode via telemedicine to avoid various costs. The predominant cost containment strategy [for surgical procedures] will involve a shift to the outpatient setting to avoid the high costs associated with full-service hospitals. Organizations such as Muve Health will drive the value through their standardized and patient-centered care pathways that are data- and metric-driven to provide top-level outcomes."

James J. Rubano, MD, Delaware Orthopaedic Specialists (Wilmington). "Obviously, with patient-centered care, we're talking about value-based care. When I first heard the term 'value-based care,' a part of me might have gotten a little upset or offended. [It almost implied] we weren't already providing value-based or high-quality care. But it allows us to show that we're providing quality care. As we move into more value-based care, to me, it's exciting in that we get to show the good job we're doing for our patients. We're able to track results and show them to the payers. We are doing a good job and being rewarded for it. Hospitals and joint replacements can be an inefficient way to perform joint replacements. With the Muve model, the whole building is set up not only for patient flow, but also for surgeon flow. If we need something, it's close by. It's not the typical ASC. This is a completely different concept — if [patients] need supervised, they stay."

Steven M. Dellose, MD, Delaware Orthopaedic Specialists. "Historically, joint replacement has been hospital-centered care. Hospitals are multidisciplinary, multispecialty and not just specialized in joint replacement. Muve is hyper-specialized, meaning they only do joint replacement and [might] branch into spine. Some ASCs may be able to perform joint replacement, but certainly not the way Muve is going to be able to perform value-based care. They're engaging fellowship orthopedic surgeons who specialize to perform these specialized surgeries at hopefully a lower cost with equal or better results. I think that's where it's really going to change the way things are done at the present time. Right now, we take everyone to the hospital. Eventually, we might take everyone outpatient. In five years, a large amount of surgeries will be performed in outpatient settings. We'll certainly see more procedures in the outpatient setting."

E. Matthew Heinrich, MD, Texas Institute for Hip & Knee Surgery (Austin). "We are already well underway to the goal of driving medicine — particularly total joint arthroplasty — to a very patient-centric experience. We have extensive studies looking at patient outcomes with minimally invasive surgical techniques, like the anterior approach total hip arthroplasty. This has allowed for these once only hospital-based surgeries to be moved to outpatient settings, especially when it is combined with an enhanced patient care and education program, like what I use at Muve in Austin. I feel like I will be doing more of what I am currently doing over the next five years, just at multiple other centers. We have already been on this path for the last four years. I look forward to seeing the rest of orthopedic care moving in this direction."

David Dodgin, MD, Texas Institute for Hip & Knee Surgery. "[Value]-based care is being prioritized and significantly affects the reimbursement for arthroplasty cases in the hip and knee. Surgeons are being forced to consider how their patient will be prepared and cared for before, during and after joint replacement surgery. I feel this is a great thing. It allows surgeons who consider and value this quality in their work to be rewarded for it and encourages them to continue to push the quality of care they always have. The issue is how does the surgeon know what hospital or group of surgeons to join so that you can truly participate in this greater emphasis on quality care? For myself and my practice partner, the answer four years ago was to look on a health partner to do it. Muve Health was the only partner who brought enough of a package to truly be confident that we could achieve our goals. Their enhanced or extended outpatient protocol is unique and designed with the patients' perioperative educational and support needs in mind. Today, we are doing what others are talking about doing five years from now. The future is here now if you seek it out."

More articles on orthopedics:
Orthopedic surgeon to know: Dr. Jeremy Oryhon of Illinois Bone & Joint Institute
8 orthopedic surgeon leaders to know
50+ female orthopedic surgeons in the US

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