Pittsburgh-based UPMC Health Plan launched its Center of Excellence program for elective hip and knee replacements in August 2019, seeking to expand access to facilities that provided higher quality and a better patient experience.
Six key insights about the program:
1. With hip and knee replacement volumes projected to rise up to 700 percent in the next decade, UPMC Health Plan created the program in collaboration with the University of Pittsburgh Department of Orthopaedic Surgery and affiliated community surgeons.
2. Nine hospitals are currently participating, with more "likely to follow," according to UPMC. To be eligible for participation, orthopedic surgeons and hospitals must be in the UPMC Health Plan network.
3. Amy Helwig, MD, chief quality officer and vice president of quality improvement and provider performance for UPMC Health Plan, said the program's overarching goal is to ensure patients have the best possible outcomes after joint replacement.
The program achieves this goal in two ways, Dr. Helwig said: One, by identifying hospitals and surgeons with the lowest complication rates, the lowest readmission rates and the best patient experience; and two, by identifying the physicians who work with patients preoperatively to address factors such as weight, smoking cessation and other medical conditions.
4. "The greatest risk of cost comes from readmissions and complications," said A.J. Yates Jr., MD, chief of orthopedic surgery at UPMC Shadyside Hospital in Pittsburgh. UPMC Health Plan aims to minimize those costs through preoperative preparation, evidence-based care pathways and outcomes-based quality improvement programs.
5. The program applies to the entire continuum of care. Surgeons optimize patients before surgery, discuss the best treatment methods intraoperatively and provide appropriate care postoperatively, following up on patients' mobility and quality of life months after the procedure.
6. The UPMC Center of Excellence program gives orthopedic surgeons in the department the opportunity to partner with providers and partners in the region, said MaCalus Hogan, MD, vice chair of orthopedic surgery at UPMC and senior medical director of orthopedic and musculoskeletal care services for UPMC Health Plan.
"With hip and knee replacement increasing in utilization, it gives us an opportunity to really be a step ahead in that environment," Dr. Hogan said.
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