Orthopedic Pearls from Remedy’s Innovation Series

The two orthopaedic faculty presenting at Remedy’s October 2015 Innovation Collaborative are successful participants in BPCI’s total joint replacement (TJR) bundle. Rob Krushell MD, from New England Orthopedic Surgeons and Medical Director for Hip and Knee Replacement at Baystate Medical Center, Springfield, MA has been working in bundled payments since 2011, first with a commercial health plan and then as a BPCI participant. Jeff Malumed MD, Chair of Orthopaedics at Taylor Hospital, Ridley Park, PA, and President of Premier Orthopaedics and Sports Medicine Associates, has participated in the BPCI program as an Episode Initiator with Remedy Partners as Convener since July 2015. 

Dr. Krushell stressed the importance of patience, collaboration and choosing to work with people who “play nicely in the sandbox.” His orthopaedic group has worked closely with the hospital and post-acute providers to create and disseminate a detailed, beginning-to-end TJR care model that incorporates venous thromboembolism (VTE) prophylaxis, pain management, early mobility, blood product utilization criteria, and the goal for a home discharge. If patients go to a SNF, 7-day a week physical therapy and a timely home discharge is specified. Also, they narrowed their network of SNFs to three main facilities. 

Dr. Malumed highlighted the importance of hiring an experienced case manager familiar with the post-acute care environment, and recognizing that “even orthopaedic surgeons can be taught new ways of doing things.” His group has made efforts to employ home physical therapy under Medicare’s Part B benefit. He believes that in most cases, Part A home health services– including nursing– are not needed for TJR patients. 

Both physicians emphasized the importance of consistently communicating the BPCI program’s goals to key stakeholders, including patients, caregivers, case managers, and physical therapists.

Together these pioneering surgeons demonstrated change is possible and in both cases, they showed it can be done quickly. In only three months, Premier Orthopedics increased home discharges by 54.5%, decreased discharges to SNF by 24.6 % and decreased discharges to inpatient rehabilitation facilities by 13.8%– while also reducing readmissions. 

While it is too early for Premier to have been through a BPCI reconciliation, Dr. Krushell’s group, working as gainsharers with Baystate Medical Center as a BPCI Awardee, has enjoyed successful reconciliations since the program’s inception in January 2014. In less than two years, his group reduced discharges to SNF by 50%, and he suggested that “they’ve only touched the surface."

There’s no place like home: Bringing to mind Dorothy’s famous exclamation in the Wizard of Oz, TJR patients are seeking a smooth home recovery from their surgery. Strong physician leadership, openness to change, and consistent messaging of program goals are critical factors in maximizing the likelihood of this outcome.