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AAOS 2015 Highlights: Are You an Attractive Partner for Surgeons Performing OP Joint Replacement?

A hot topic in orthopedics over the past few years has been the shift of hip and knee replacement surgeries to the outpatient setting. The heat was turned up a notch at this year’s American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting, with no shortage of poster presentations, symposia and courses dedicated to the topic.

Hospital providers still grapple with the value equation to attract orthopedic surgeons to their organizations, balancing the interests of both the hospital and independent physician groups, while keeping the patient at the center of care decisions. This has proven to be particularly challenging in discussions around outpatient hip and knee replacement. Thus, achieving the right formula for patient selection and management to optimize site of care efficiencies for these procedures is essential to orthopedic strategic planning.

Matchmaker, Matchmaker, Make Me a Match
The value equation is still king in bringing in orthopedic volumes, and yet there’s no single reliable tip or trick for substantial orthopedic volume growth at every organization. The good news gleaned from this year’s AAOS is that through your experiences in bundled payment initiatives, comanagement agreements and population health–related activities, many of you have mastered the care path to effectively demonstrate value.

As we learned in the practice management session, the 2014 AAOS consensus survey results of over 6,800 practicing orthopedic surgeons indicate that 16% of full-time orthopedic surgeons are now employed by hospitals. Each of those surgeons is performing a mean of 30 surgical procedures per month at your organizations. Perhaps that eases the burden of differing priorities and incentives for a small subset of hospitals, but it still leaves an 84% majority of surgeons whom you don’t employ. What’s the take-home message out there for those providers?

Orthopedic surgeons are emphasizing the importance of partnering with the right entity to enhance their value proposition. Whether or not you employ orthopedic surgeons, these providers are looking for partners who can collaborate with them to achieve the best outcomes and value through episodic cost of care management. The simple question becomes, “How are you ensuring you are the most attractive partner for your independent orthopedic surgeons?”

Sg2 Forecasts a Continued Shift to OP for Joint Replacement
We’ve enjoyed many conversations with hospital and health system leaders over the past few years about the shift of more and more orthopedic and spine surgical procedures to the outpatient setting. I was invited to speak on a Friday morning panel at AAOS about Sg2’s outlook on outpatient joint replacement called Outpatient Hip and Knee Replacement: The Changing Landscape—What You Need to Know. I was in for 2 big surprises that morning.

My first surprise? There wasn’t an empty seat for the 5:30 am (yes, am) course, demonstrating the relevance of this topic to surgeons. My second surprise? It happened when I provided a sneak peek into Sg2’s 2015 forecast for hip and knee replacement, which predicts that, nationally, 20% of these procedures will be performed in the outpatient setting by 2025. I couldn’t resist asking these surgeons who thought this 20% shift was overestimated. You would have thought I asked how many were in support of permanent adoption of Medicare’s Sustainable Growth Rate formula. Not one hand went up. Granted, these are the surgeons most interested in outpatient joint replacement, but the overwhelming majority of participants believe there will be an even more aggressive shift.

So, you ask, what’s Sg2’s perspective? We believe there’s a place for outpatient joint replacement for a healthy subset of the patient population. However, we also believe adoption of this practice requires careful clinical and strategic consideration.

  1. Create clear care pathways. First and foremost, the overwhelming message from all key constituents was that performing outpatient hip and knee replacements requires seamless execution of care protocols that carefully define the appropriate patient population, limit soft tissue damage during the surgical procedure, include clear patient education, effectively manage pain and encourage aggressive patient mobility.
  2. Obtain buy-in from your orthopedic surgeons. Not all orthopedic surgeons feel outpatient hip and knee replacements are a safe and effective alternative to short-stay inpatient episodes, even for a subset of patients. Poll your surgeons to get their perspective, and ensure they have performed an adequate volume of these procedures in the inpatient setting with good results prior to considering performing them as an outpatient procedure.
  3. Consider payer dynamics. Assess the payer situation in your market. Markets with more aggressive bundled payment and direct-to-employer contracts in orthopedics will be more likely to experience a more rapid shift of these procedures to the outpatient setting.
  4. Be aware of partnership alternatives. Traditional hospital campuses, existing ambulatory surgery centers and newcomers to the market all pose a potential threat to your joint replacement volumes should these entities prove to be more collaborative partners for your orthopedic surgeons and their initiatives.

Careful consideration of the growing trend toward outpatient orthopedic surgery will be key to ensuring you’re an attractive partner for surgeons in the future. Whether you formally partner or informally collaborate, involving surgeons in your strategic planning efforts is imperative.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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