As with all service lines, orthopedic services generate a significant amount of data that can be collected. But what data points are the most relevant for hospitals and physicians seeking to improve the service line value? Mr. Wells suggests starting with preoperative planning and capturing measures throughout the continuum of care. He says it is important to track patients' clinical background, especially their comorbidities, to understand how patient outcomes differ based on patient acuity.
Intraoperative metrics that should be measured are those that relate to surgical technique, such as the surgical approach, according to Mr. Wells. In addition, the type of implant used should be recorded to determine different implants' efficacy and quality.
Post-surgery data is essential for evaluating patient outcomes. Mr. Wells suggests comparing expected outcomes to actual functional outcomes in the short and long terms. Functional outcomes describe how a patient functions after the procedure, such as range of motion and the ability to walk without assistance. "We need to move beyond thinking about length of stay and readmission rates and get more granular," Mr. Wells says.
Data broken down by patient acuity, procedure, implant and other characteristics can help hospitals more effectively identify trends and opportunities for improvement. Data may show a correlation between certain processes and outcomes, which can allow providers to make evidence-based changes to improve outcomes. For example, Mr. Wells says data may show that patients with a high body mass index have a higher likelihood for contracting infections. Using this knowledge, hospitals and physicians can take prophylactic measures to prevent infection, he says.
Data collection payoff
Data on implants can be useful for hospitals and physicians because they can provide evidence for choosing one implant over another. Standardizing implants among physicians can save costs. Mr. Wells says implants can account for up to 40 percent of the base cost on an acute event for orthopedic bundled payments. Lowering implant costs can thus save the institution a significant amount of money over time. "In the implant-related world, you need to measure [implants] because in some way we are paying premiums for specific devices that promise increased function," Mr. Wells says. "But do we have a critical mass of data to determine the price premium is equal to the value to the patient?"
Tracking functional outcomes is important because they provide a measure of quality for patients — a measure that notes not only the absence of bad outcomes, but the level of positive outcomes. "You can't just measure failures," Mr. Wells says. "You have to measure successes and degrees [of success] in the relationship between how much money goes in to get [the successes]."
Knowing the exact quality of orthopedic services can help hospitals attract patients. "With risk-bearing models being pushed upon [providers], they now realize population management and being able to market themselves related to quality is really a potential upside in this transition from volume to value," Mr. Wells says.
Initiating a culture change to focus on data
Service line data is most useful when it is captured in real time and shared with administrators and both acute-care and post-acute-care physicians at least quarterly, according to Mr. Wells. Communicating data can promote collaboration and help providers coordinate patient care across the continuum. "If it hasn't happened already, there's going to be a cultural change to where parties are learning from each other; you need that type of culture," Mr. Wells says.
Sharing data can engender trust between hospitals and physicians and prevent conflict by providing a common basis of facts. "The foundational piece is the trust between physicians and hospital leadership," Mr. Wells says. Using data to drive decisions is particularly important when introducing new care delivery and payment models, such as bundled payments. "There are plenty of strained relationships between physicians and hospital executives. Without enough good data, a bundled payment program could throw fuel on the fire," Mr. Wells says.
Instead, hospitals and physicians need to work together to collect and analyze data and use the information to improve quality and lower cost.
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