New Joint Replacement Care Platform Could Simplify Transition to CMS Bundled Payments

Don’t Breathe, a current box office hit, is about a couple of guys who target the wrong person for a break-in and are trapped inside a seemingly helpless victim’s house…with dire consequences for those trapped. 

As I read the film’s review, I thought of how similar this might feel to physicians and hospitals as they feel trapped inside the “CMS House of Bundled Payments,” for hips and knees, which is currently being implemented in 67 different geographic areas in the United States. With rare exceptions across the country, hospitals and orthopedic surgeons have little true knowledge of exactly what the total amount a joint replacement should cost in a bundled payment model and even less expertise in setting up contracts to accommodate the various components of the care.  Tie this to the decreased CMS payment model and you truly have a scary scene.

The CMS Comprehensive Care for Joint Replacements (CJR) model is attempting to financially bind together the various vendors involved in major joint replacements, so that they to work together to improve the quality and coordination of care from admission through recovery, and at the same time satisfy all of the very demanding stakeholders. These stakeholders include physical and occupational therapists, home health care, nursing homes, anesthesia, primary care, specialty care, pharmacy, hospital, supplies and virtually anything else you can imagine these patients needing.

Hip and knee replacements are the most common inpatient surgery for Medicare and can require very prolonged and costly recovery and rehabilitation time periods.  The health of the patients undergoing this procedure varies, but suffice to say, they are not typically triathletes!  CMS reports costs ranging from $16,500 to $33,000 for the same procedure in different locations, with widely varying outcomes.

So, how can a diverse set of surgeons on a typical hospital staff become aligned to design a system and program to fulfill this growing CMS mandate? A small company with roots in Birmingham and St. Louis, Orthopedic Centers of America, may just have the answer.

The company was founded by Dr. Kenneth Bramlett, a highly skilled orthopedic surgeon, and Affan Waheed, an entrepreneur, who was previously director at Express Scripts and the former executive director at Mercy, a 34 hospital system in the Midwest. Orthopedic Centers of America have just gone live with a new platform that can take existing highly detailed data from hospitals and identify the gaps that create much of the variability in orthopedic care; including outcomes, lengths of hospitalizations, readmissions, cost of supplies, infection rates, physician variability, and overall cost of care issues.  It also incorporates data on the individual characteristics of patients from a variety of data sources to create a Digital Patient Profile and patient scorecard.

Their platform uses all of this data and analytic capability to then create actionable plans that identify key areas for improvement in both the physician and hospital realms to prepare for CJR. For instance, the company helps hospitals develop patient identification processes, reimbursement profiles, a pre-habilitation program to prepare patients, inpatient and outpatient management protocols, and overall clinical and outcome management.

But Orthopedic Centers of America is not just a data warehouse and analytic platform.  They have combined forces with ConcertCare, a nationally recognized telemedicine platform previously mentioned in this commentary to allow much of the pre-op and post-op care to be performed remotely.

The Orthopedic Centers of America model also involves a clinical differentiated approach. This approach includes using general instead of epidural anesthesia, no need for a tourniquet, a minimally invasive surgical approach, a soft-tissue-balancing-surgical technique, and more. Their results speak for themselves: very short operative times, few post-op bladder issues due to anesthesia, fewer infections, little to no need for the use of a continuous passive motion machine (an expensive part of post-op care), early ambulation with 95% expected to go straight home instead of to a nursing home, little need for home health care. Most importantly for managed care and CMS, The Orthopedic Centers of America model includes only a 2-day length of stay and negligible readmissions.

These outcomes are not pie in the sky, but have been proven for years in clinical practice at a major joint replacement hospital in Birmingham. They have proven that they can provide CJR care for literally half of the current national average, all with outstanding patient satisfaction ratings.

But this is not all —  their parent company, Healthcare Excellence LLC (Hecarex), has also announced the development of a cardiac module.

Orthopedic Centers of America has again proven the power of data and precision analytical processes and how this approach will rapidly transform health care in America and allow hospitals to meet the new CMS CJR demands.