Orthopedic center may test health reform law
by Lesley Wright, The Arizona Republic
May 6, 2011
Banner Del E. Webb Medical Center administrators gathered hospital employees Friday to announce a joint venture with the CORE Institute that could be a early test of the health-care-reform law for patients and physicians.
By the end of the year, orthopedic patients will be treated at the Banner CORE Center for Orthopedics, a limited-liability company operating out of the Sun City West hospital.
The model calls for orthopedics patients to go through a seamless "continuum of care," from initial exam to postoperative rehabilitation. At the same time, the partners will learn how to co-manage healthcare costs during the three-year pilot period.
The center will give patients one integrated treatment and, eventually, bill for one payment under a new "bundled" reimbursement system. Even bonuses will be based on group performance.
CORE, the Center for Orthopedic Research and Education, approached hospital administrators in 2010, ready to pour $5.8 million into the venture. The center's board, co-managed by CORE and the hospital, will handle every aspect of orthopedic care at Del E. Webb.
David Jacofsky, CORE CEO and an orthopedic surgeon, said his company decided to partner with a hospital once he saw that health-care reform was heading toward integrated, standardized care.
"We will re-engineer patient expectations," he said.
Banner Del E. Webb CEO John Harrington summed up the new management trend in the first slide of his presentation: "The whole is greater than the sum of its parts."
Dr. Charlie Agee, chief medical officer for Banner Del E. Webb, said, "The next 10 years of medicine will probably be the most interesting of any decade in the past. This is where we need to be in the future."
New patient experience
The primary change in the care model will be the bundled payment system, where Medicare and other insurers pay a lump sum for the patient's treatment, instead of the fee for service that compensates medical professionals on a per-diem basis.
If a surgeon today has to operate on a patient five times because of complications, he or she is paid five times. That will stop under bundled care and should reduce the number of copays.
Medicare has rolled out pilot programs for bundled payments and intends to have it open for all states by 2013.
Arizona is not a pilot state, but Harrington said the center will apply to be a pilot program for its own bundled-payment system in 2012.
Banner wants to be ready to offer high-quality orthopedic care under the new health-care system, Harrington said. That means that all involved practitioners - from nurses to physical therapists -will have to consider the whole patient.
"With health-care reform, the dollars are going to be less and less at our disposal, so we have to be more efficient with our healthcare," Agee said. "We have to worry about putting together this care pathway."
Banner Del E. Webb has the second-highest volume of orthopedics patients in the Valley, just behind Scottsdale Healthcare.
Three orthopedic groups now practice at the hospital. Those in the new center will use the same methods and standards and have a metric system of goals to measure quality.
"To participate in our program, everybody is agreeing to do it the same way," Harrington said. "It is evidence-based practice."
The CORE Institute opened in Sun City West in 2005 with three doctors. It now has 31 physicians, 19 physician assistants, four therapy centers and seven locations around the Valley. The institute includes 24 companies that research new equipment and treatments. In the future, patients can expect to see robots, radio frequency and Bluetooth technology incorporated into their care.
One of the new innovations piloted at Banner Del E. Webb is Secure Track, a ceiling-mounted support device for patients who have had hip joints replaced. Holding on to the device, they can practice walking without a fear of falling.
Patient Shirley Madkins, a 62-year-old Sun City West resident, said the track system made her feel secure as she walked at a relatively normal gait just one day after surgery.
"It's phenomenal," Madkins said.
Doctors, nurses and other staff will give patients more information about what to expect before they are admitted to surgery and after they leave.
The orthopedics center is growing, adding spinal surgery and the expanding treatment of sports injuries. The department performed 2,000 joint replacements this year, compared with 500 surgeries in 2005.
Jacofsky is excited about health-care reform because the old system was outdated. Standardization of care means that all professionals on a team follow proven protocol.
"We will continue to be national leaders in new technology," Jacofsky said.
Preparing for reform
Moving forward, Medicare will be looking for large practices that tie cost-efficiency with the best patient outcome.
Banner Del E. Webb and CORE administrators spent a year constructing the partnership between the non-profit hospital and the private institute. But they believe it will put them in a good position as health-care reform moves forward, with a management model that can be replicated at other Banner centers.
"The better the value, the more Medicare will want to be aligned with us," Agee said. "That is where we need to be in the future."
Harrington said that high quality and lower costs will help the country create its own style of accessible care.
"I think in the U.S. we will try everything possible to create an efficient system ourselves before national health insurance is forced on us," Harrington said.
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