Here, Rothman Institute Founder Richard Rothman, MD, President Todd Albert, MD, and CEO Mike West are joined by Rothman Specialty Hospital CEO Kelly Doyle and Nueterra Healthcare COO Marc Goff to discuss the benefits, challenges and uniqueness of orthopedic specialty hospitals.
Q: What was your objective in founding Rothman Specialty Hospital?
Dr. Todd Albert: We wanted to create an experience where the patient can get superb surgical and medical care in a very unified way. We are only taking care of musculoskeletal services there, so it is very focused. People have a concierge service and great food service. The outcomes are outstanding and surgeons love working there, so it makes the patient experience better.
Dr. Richard Rothman: This is a center of excellence. The term was coined in 1970 to describe a specialized hospital in England just for joint replacement. The idea was that the hospital only focusing on orthopedics would have better outcomes, lower cost and better patient satisfaction. We have learned the road of excellence is paved when an institute focuses on just one specialty. Now, 40 years later, I'm struck that patients who have a choice of a university and general hospitals invariably comment how much better their experience is at the specialty hospital. Even people in public service say they want to come here because of our focus on musculoskeletal care.
Mike West: For us, the team working together to provide medical care is often the same. In many instances, you don't get that level of consistency at a general hospital. Here surgeons get the same staff all to time. Just as the surgeon gets better with every case they do, so does the staff become better and more efficient.
Q: What makes Rothman Specialty Hospital unique?
Kelly Doyle: I think it's the people who work here. To begin with, the Rothman Institute surgeons have very high expectations of themselves, but that doesn't just stop with the surgeons; everyone on the team must be high-achieving, including nurses, administrators and cleaners. They are very much engaged in the whole management and care processes, from the preoperative examinations to postoperative rehabilitation. Everyone knows the bar is high.
This type of organization isn't a good fit for everyone because a lot of people could just do the bare minimum and get away with it. That just doesn't happen here; the expectations are shared with the employees upfront. Whoever gravitates toward working with Rothman are superstars. Everyone who works here aims to be part of something great and therein lays the difference.
Marc Goff: You see that the group of physicians put their patients' safety and quality and superior outcomes at the top of their focus consistently each and every day. They truly utilize a team approach to care for their patients. They are intimately involved in patient satisfaction and outcomes. It is a privilege to be part of the group of physicians who wake up every day and think about how they can improve patient care.
Q: What challenges has the hospital faced and how were you able to overcome them?
KD: On our side, the challenge has been that this is the first time anyone in the organization ever opened a hospital. Most people are closing their doors and folding their programs today whereas we are coming in and opening up a hospital. The biggest obstacle was the trust factor; if you were at bigger hospital, you already know the peripheral services there have been running for a long time. Everything here was brand new and the obstacle was to build a team that could offer the same level of services to the surgeons than other places.
We were able to overcome this challenge by employing the right people. Everyone is very engaged with their team and the surgeons. Rothman Institute surgeons aren't the type of people who just show up; they build a routine and get the right people in place. That doesn't happen over night but we are there now and the surgeons are happy.
TA: One of the biggest challenges has been demography and geography. Our surgeons would rather operate on their patients here, but if the patient is coming from farther away they want to do the procedure closer to home. The hospital is in the far northeast area of Philadelphia, which isn't convenient for everyone.
Another challenge will be ultimately what happens with the entire healthcare world as the insurance market is being closed and insurances are telling patients if they choose to go somewhere else for surgery, they have to pay more out of pocket instead of going to the lower cost place with lower quality. We haven't seen it much yet, but I think it's a future challenge for the hospital.
Q: With the cap on physician-owned hospitals and POH expansions enacted in 2010, where do you see the hospital going in the future?
MW: We only have a limited number of beds and operating rooms; this is one of our challenges because once we hit the maximum we can't grow anymore. There must be some sustainable growth due to cost challenges, but growth will be limited in the future.
Because we don't know where healthcare is going, our strategic plan isn't reliant on that; it's reliant on quality and cost. We are working on a functional outcomes database system and trying to improve our IT integration through business intelligent systems and integrating business and clinical information. We are also monitoring patient satisfaction to see where we can make improvements on that. Regardless of what happens from the regulatory standpoint, if we continue to focus on those things, we should come out on top.
Q: Why can an orthopedics-only hospital like Rothman Specialty Hospital succeed post-reform?
RR: The cost to society is less. We work in a world where we have very expensive high cost technology and the way to lower that cost is have higher rates of utilization. We have operating equipment that is very expensive but since we do a high volume of procedures, that cost tends to be amortized more quickly.
MW: The other thing that helps us on cost is in a general hospital physicians don't have access to all the costs of the episode of care. We have access so there is transparency. With the cost accounting systems we have, we are looking at ways we can reduce costs without lowering care. We think it will be lower cost and higher quality over time.
TA: A big portion of that is implant cost; you look at staffing and efficiency costs as well. The staff per case basis is different because of efficiency — throughput is higher, so per case cost is lower. Staff is a fixed cost pre- and postoperatively. We look at the variable cost associated with all of these cases, and the physicians look at the costs case by case. We look at the approach and see where there is variation. We think it helps to lower cost from preoperative to postoperative care just by getting the data to physicians.
Q: What are the benefits of a specialty hospital focusing only on orthopedics?
KD: We do so much of it that we get really good at it. I've worked in a lot of different areas in surgery over my career and the key to efficiency and perfection is doing it over and over again. Everyone understands what is taking place, which is the beauty of a specialty hospital.
MG: I think as your dedicated to orthopedic and spine excellence, and when that is what you are doing every day, your focus isn't diluted with multiple specialties. Staff knows the key terms and key times and understands the delivery of care because they are focused on orthopedic patients each and every day.
MW: We do approximately 9,000 joint replacements system-wide. They have seen every aspect of this and done research on the best approach. To take that into an orthopedics-only hospital makes it even better.
TA: If you do a huge volume of things you've seen almost every weird thing that can happen and you're prepared for it; that makes a big difference. Everyone does the same thing over and over again — it's very comfortable for the surgeon to have a well-versed nursing staff and anesthesiologists who know all the subtleties to orthopedics cases.
Q: What is your strategic plan for the future?
KD: I hope to have increased volume. I would like to see every bed filled and to run out of space; that would be a good problem to have. We also want to maintain our high levels of patient satisfaction and quality. To be busy and maintain our patient satisfaction and quality is my goal. In the future, we hope people will be visiting the hospital from all over the place to see how it's done.
MG: From our perspective, the plan is to listen to our physicians and partners. Rothman Institute has a very aggressive approach and they are very proactive in their approach to healthcare and patient care. They are always looking to the future.
TA: If the government stays out of our way, we would expand the hospital and make other Rothman Specialty Hospitals in other locations more convenient for patients. We have soon to be 20 clinics in the tri-state area. We would similarly have another hospital or two hospitals in the demography to try to make it more easily accessible for patients, so they can have a higher level of quality care. Today, we are prevented from doing that because of the laws.
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Why a Physician-Owned Orthopedics Specialty Hospital Can Succeed: Q&A With Rothman Specialty Hospital FeaturedWritten by Laura Miller | July 10, 2012
Rothman Specialty Hospital, based in Bensalem, Pa., is a 65,000-squre-foot facility in partnership with the physicians of Rothman Institute. The hospital focuses only on orthopedic and spine cases and includes six fully-equipped operating rooms. It is accredited by The Joint Commission and Medicare.
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