Dealing with osteoarthritis (OA)/rheumatoid arthritis (RA)/avascular necrosis? If you need a total hip replacement, you might want to consider one of the top 25 facilities in the country. They have done their homework, and figured out how to deliver expert care and relatively reasonable prices.
What these hospitals have in common:
High volumes: these 25 hospitals average 394 total hip surgeries per year, whereas the U.S. average is 43.
Low prices: the average charge was $27,786 compared to the national average of $54,050.
Source: PearlDiver Technologies, Inc.
Here’s how four of these top hospitals become the best in the country:
Indiana Orthopaedic Hospital
Frank R. Kolisek, M.D. is a joint replacement specialist at Indiana Orthopaedic Hospital. We asked Dr. Kolisek, past president of “OrthoIndy,” what his facility did to make it one of the top 25 in the United States for this surgery. He told OTW, “We focus on the care of the patient and their family. We want the patient to receive the best possible orthopedic care and we want them and their families to have a great experience while ‘visiting’ our facility. We believe that if you take good care of the patient and do what is necessary to achieve this goal, then everything else takes care of itself. We don’t focus on the bottom line, but rather we focus on getting the patient treated for their orthopedic problem in the best way possible. Doing this rather than cutting corners makes a big difference in patient outcomes as far as we are concerned. I’m proud that our staff being so efficient that there is no duplication of services. The staff is just wonderful, and makes patients feel like VIPs; and we don’t wait for patients to hit the buzzer to provide pain medication. Overall, if we can deliver great outcomes, then the patient will benefit, they and their families will have a great experience and we will help lower health care costs by providing high quality care with low complications.”
We then asked Dr. Kolisek about his hospital’s average charge for this surgery—$30,031. “What is interesting is government insurance programs and insurance companies have negotiated rates for elective orthopedic procedures such as a hip or knee replacement,” he said. “Therefore, they pay the hospital a set fee regardless of what the hospital charges actually are, so charges in and of themselves are not useful. Bundled pricing is catching on at this time as well. We look at what resources it takes to deliver a high quality orthopedic procedure and we don’t ‘add on’ to cover something else. Certainly, we hope the reimbursement we receive covers our costs.”
As for how they get patients discharged as soon (and as safely) as possible, Dr. Kolisek explained, “Patient education and having a team that understands the game plan are the most important factors in achieving good outcomes with timely discharges to home. When patients understand what they are getting ready to go through and what is expected of them, then things go better as surprises have been eliminated. Getting their families and friends involved in their care is also quite helpful.”
St. Francis Hospital and Medical Center
The Connecticut Joint Replacement Institute (CJRI) at St. Francis Hospital and Medical Center is also amongst the best in the U.S. Steven F. Schutzer, M.D. is medical director of the CJRI and president of Connecticut Joint Replacement Surgeons, LLC. He told OTW, “Since CJRI’s inception on July 31, 2007, our prime focus has been on generating sustainable healthcare value for our patients. We have been successful in doing so by a strong commitment to standardizing our approach to the delivery of care for our joint replacement patients; our care plans are all protocols driven. We have established a continuous process improvement methodology that follows this scheme: ‘measure…assess….adjust….implement….adjust… measure…’”
“Also, we pay careful attention to cost and supply chain spending; this is guided by evidence-based decision making. We have created a culture of excellence throughout CJRI…one that every member of our diverse family of dedicated staff helped write and now live; this captures broad buy in. In addition, we provide real time feedback to our surgeons on outcomes and cost, and make it a point to engage the patient and family in their care. We also think it’s important that we have a cadre of high quality fellowship trained arthroplasty surgeons managing the service line.”
We also asked him about his facility’s charges—a quite modest $24,355.49. Dr. Schutzer told us: “The answer to the question has to be predicated upon an assumption that we are comparing ‘apples to apples,’ an assumption that I suspect is flawed. Hospital charges are meaningless. As you likely know, hospital charges and their costs have very little correlation. At CJRI and St. Francis Hospital, we have an outstanding finance department with whom we have worked with for many years now to ‘clean up’ our cost data. So, we know, with substantial accuracy the cost of delivering total hip and knee arthroplasty. Having access to clean cost and outcomes data, three years ago, we implemented a bundled payment program for primary THA [total hip arthroplasty] and TKA [total knee arthroplasty] based on real costs of delivering this service. We run a lean, highly efficient, high quality arthroplasty institute. I would urge you and your readers to not place much credibility on published hospital charges for these or other procedures.”
Concerning discharge, Dr. Schutzer stated, “The answer to this can be traced to the responses to your first question. Reducing length of stay is a complex undertaking with multiple nodes and decision points any one of which can affect the success of the effort. That said, in six years, as a result of our care plans, we have reduced the LOS [length of stay] from 4.2 to 2.7 days for our total joint patient population. Safety is a key issue and is part of the CJRI culture that has been cultivated since we opened. To address one of the most devastating safety issues for hospitalized patients…in-hospital falls…we have implemented a ‘Call, don’t fall’ program. This is actually a contract between our staff and our patients that they sign on admission in which they agree NOT to get out of bed or chair without assist (until deemed safe by our safety team) and in which we agree to respond to their calls for service in a timely fashion. This has reduced the incidence of our falls by 60%.”
Sanford Medical Center Fargo
Arlene Biberdorf is vice president of Ortho/Neuro/Rehab for Sanford. Regarding all they are doing right in the realm of total hips, she told OTW, “Total hip patients come to their surgery prepared. All patients are encouraged to attend pre-op class in a group setting and/or a 1:1 learning session. Literature reveals patients who attend a pre-op class are more confident in their ability to recover from surgery with encouraged independence. By reducing anxiety, patients are engaged in their care and have a sense of improvement in their quality of life. We have earned The Joint Commission’s Gold Seal of Approval for the total hip replacement program. We voluntarily seek national certifications to validate our commitment to practicing the best standards of care so we can achieve the best outcomes possible.”
Regarding their charge for this procedure—$30,773.53, Biberdorf stated, “The total charges for these cases is a total of the individual services provided to the patients, while receiving care. The services can range therefore the cost changes.”
As for getting patients sent home in a timely and safe manner, Biberdorf commented, “Pre-op discharge planning is essential so that the transition from the hospital setting is seamless, and patients are aware, before their surgery of the 2 night/3 day length of stay. During their stay, transition rounds are performed daily, with the patient and our interdisciplinary team (nursing/PT/OT/Case Management/Pharmacy). By having consistent communication between the patient and all the team members, this ensures a safe and timely transition from the inpatient setting.”
New England Baptist Hospital
David A. Mattingly, M.D. is chief of adult reconstruction and director of the Otto E Aufranc Fellowship at New England Baptist Hospital (NEBH). He told OTW, “We rank in the top 25 because we provide high quality and high value with low complication rates. All surgeons are fellowship trained and work together to establish protocols that produce high patient outcomes and satisfaction. And our educational program, including the training of five fellows each year, provides a knowledge base that is stimulating and current.”
Concerning this facility’s charge for total hip surgery—$24,204.64, Dr. Mattingly told OTW, “The price of a surgery varies based on the individual needs of each patient. Some patients are more complex with comorbidities such as diabetes or cardiology issues. These patients require additional services to support their surgery. NEBH always makes an effort to provide high quality and high value. We do everything we can to keep costs down through increased efficiency and evidence-based protocols.”
To the point about safe and timely discharge, Mattingly noted, “Our preadmission screening process is very thorough. It is designed to keep infection rates low and eliminates some of the potential complications post-surgery. We also spend a lot of time educating our patients prior to surgery. By doing this patients are better prepared for surgery both physically and mentally. Empowering the patients and making them partners in the surgical process helps to get them ready to go home faster. Our active physical therapy program also helps. Working with patients before the surgery and getting them mobile quickly after the surgery also contributes to a shorter hospital stay.”
The research for this ranking was performed by PearlDiver Technologies, Inc., a company with a proprietary database that includes more than one billion patient records and includes Medicare (deidentified) and private payer data as well as specific industry data as compiled by PearlDiver’s team of analysts. (PearlDiver Technologies, Inc. is affiliated with Orthopedics This Week.)