In orthopedic surgeries, having data is essential to making decisions that result in the best outcomes at the lowest costs. Yet that goal is difficult for providers when there isn’t transparency between the cost of an implant or procedure and the outcome for the patient.
Last December, the Nashville, Tenn.-based Hospital Corporation of America (HCA), began to roll out a solution (supplied by the Nashville-based InVivoLink, Inc.) for orthopedic and spinal implant procedures at its TriStar division, which encompasses 12 of its acute-care hospitals in Georgia, Kentucky and Tennessee. The solution, which was first implemented at Skyline Medical Center and Centennial Medical Center, both in Nashville, has now been rolled out in all of the TriStar division hospitals.
The solution captures and disseminates metrics tied to episodic care of implant procedures, and provides transparency between the costs of the procedures and the outcomes for the patients. The data is presented through a real-time dashboard, and aggregated into a Level III data registry that physician practices can use to benchmark their procedures against other practices and make better decisions based on evidence.
Level III data registries track data such as surgical technique, implant identity, failure rates, functional outcomes, patient satisfaction, and patient profiles. InVivoLink gives HCA a scalable way achieving a Level III registry. Capturing this level of information gives physicians, service line administrators, and other decision-makers clear visibility and understanding through per procedure financial and quality metrics, and real-time analysis. This enables hospital administration, service line managers, and physicians to objectively assess a joint program and take action that improves value by understanding the effectiveness of implant design and provide information back to surgeons about performance while accounting for different clinical and operational variables.
Douglas Ardoin, Jr., M.D., chief medical officer of the TriStar Division, says that among its advantages at TriStar, the solution has allowed physicians to gain a better understanding of their own practices compared to other practices in the database. (He also notes that surgical specialty organizations often require physicians to use some sort of registry functions in their practices to maintain their certification requirements, which is another incentive for using the solution.)
Ardoin says that the solution is used for patients undergoing hip and knee surgeries—an important surgical category because of the growing population of older patients, noting that decisions around this type of surgery involve different varieties of implants and surgical procedures, depending on the age and activity levels of the patients undergoing surgery. “It’s nice to have an application that can track all of that, and match the demand,” he says. He adds that the solution allows physicians to track the surgical procedure, whether minimally invasive or standard; outcomes and incidents such as surgical site infections; and how the patient progresses through physical rehabilitation and rehabilitation.
“You can connect those dots and begin to understand some things about the practice or the population or the implants that you didn’t know before,” he says. The value, overall, is being able to tie information together in a single database that can point the provider organization in a direction that drives higher quality and better outcomes for patients, and that is, hopefully, more cost effective.
Prior to using the solution, much of this information was gotten manually, by exhaustive chart reviews, by sending out paper surveys to physicians or to patients trying to understand what happened after surgery, he says. “I’m not saying that was not effective, but it was definitely working harder, not smarter,” he says.
According to Ardoin, one advantage of the solution is that it allows physician to glean data such as surgical site infections, and compare his rate to national rates. He speculates that more hospitals will use these types of registries in the future to compare their outcomes against national averages.
He says the solution will allow the provider organization evaluate how well its physicians are demand managing. “With that information, you can go to your cohort orthopedic surgeons and show them who are doing a really good job with this, who isn’t, and how it impacts the cost of care,” he says. He believes the tool can help surgeons understand their current decision-making process and adjust it when they see an opportunity to make it better.
Ardoin says the solution can be a helpful tool for hospitals and physician practices engaged in bundled payments and population management care, which require having a deeper understanding of what works at getting the best outcome, with the highest quality and the highest level of cost-effectiveness. “In a bundled-payment method or the population health scenario, it’s not a revenue play anymore; it’s a cost mitigation play,” he says. “If you are using expensive materials that aren’t necessary and don’t bring added value, you need to know that. And if you’re doing things that cause complications so that patients have to come back and have something done again, you don’t get paid twice. That’s cost.”
