Creating efficiencies and foraging partnerships with physicians could help hospitals slow outpatient migration, two orthopedic surgeons told Becker's.
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Editor's note: Responses were edited for style and clarity.
Question: What can hospitals do to slow outpatient migration in orthopedics?
John Corsetti, MD. New England Orthopedic Surgeons (Springfield, Mass.): Out-migration of orthopedic surgical procedures from the inpatient to the outpatient setting has seen an inexorable increase over the past three to five years and, by all estimations, will continue and even accelerate. While most agree this migration is, generally speaking, a favorable event both for patient and provider satisfaction as well as overall quality of care, the loss of inpatient revenue for health systems is substantial.
One strategy that health systems have used with success to moderate the pace of migration is the creation of co-management arrangements with orthopedic providers. These agreements financially incentivize providers based upon quality and performance metrics, while allowing for heightened levels of service line control. A well conceived and executed co-management agreement typically results in improved satisfaction across every tier of the care team, in addition to enhanced patient satisfaction and even clinical outcomes. These agreements create a working partnership between the providers and the health system, aligning goals and incentivizing the attainment of mutually agreed upon measurable metrics. Many providers who have entered these arrangements have commonly seen inpatient care efficiencies improve to approximate those observed in the outpatient setting.
David Coward, MD. Retired orthopedic surgeon (Sacramento, Calif.): It's very simple — be more efficient. It took me twice as long to do my knee arthroscopy cases in the hospital than in the outpatient setting.