NYU Langone Medical Center joined the Bundled Payments for Care Improvement program in 2013 for total joint replacements and experienced success over the past three years. Professor of Orthopedic Surgery and Vice Chair for Clinical Affairs at NYU Langone Medical Center Joseph Bosco, MD, and his team re-designed their care model and embraced bundled payments to develop better outcomes, refine home care pathways and lower the cost of care.
“We needed to change the way we looked at total joint replacements,” says Dr. Bosco. “There has to be a value proposition for every procedure, test and patient we treat. We have to justify
the costs with the outcomes and develop best practices.”
The NYU Langone program is unique because although it’s an academic medical center, the orthopedics department includes around 120 active orthopedic surgeons. Not all of the surgeons are employed at the hospital — about half are independent physicians aligning with the hospital.
Here are five key thoughts on why NYU Langone’s BPCI participation was successful.
1. The entire surgeon team helped create care pathways. “We worked with all surgeons to develop a care pathway that the vast majority bought into, and that’s better for the patients,” says Dr. Bosco. Before BPCI, 75 percent of the total joint patients were discharged to skilled nursing facilities; now only 25 percent are discharged to SNFs and the rest go home.
“That’s much better for patient outcomes and leads to fewer readmissions and complications. Ultimately, the episodes of care are less expensive as a result,” says Dr. Bosco. “Patients understand the value-add for being discharged home.”
2. They switched to reference pricing for implants. Reference pricing can decrease implant cost and standardizing the implants will reduce variation. NYU Langone experienced a 30 percent drop in implant costs after implementing reference pricing. “In BPCI, the implants are part of the DRG, but it’s still an important opportunity to reduce costs,” says Dr. Bosco.
3. Care coordinators check in with patients to smooth the transition home. Care coordinators monitor the patients sent home to ease the transition. The coordinators call patients for updates to catch issues before they turn into big problems. “This is a big deal,” says Dr. Bosco. “We want to make sure the patients have someone to talk to when they return home. That’s important to our success in the post-acute care world.”
4. Take advantage of all cost-saving opportunities. Dr. Bosco and his team found several ways to cut down the cost of care and improve outcomes overall:
- Eliminate unnecessary lab tests
- Establish physical therapy pathways on the day of surgery
- Lower pain management postoperatively with non-narcotic medications
5. Data and cost transparency will drive success. Surgeons want to provide the best care for their patients and data-driven pathways will support the surgeon’s recommendations as they work with patients to develop a care plan. Orthopedic surgeons are also competitive, and sharing outcomes and cost data will highlight the best performers while showing others improvement is possible.
“You have to present the data to physicians and patients, especially data about being discharged home. Show them going home is a better option for them and their outcomes. It can also decrease complications,” says Dr. Bosco. “We were able to use the data to find areas for improvement. We realized patients needed extra support for rehabilitation to prevent readmissions, so we sent nurses and therapists to their home.”