Centers of Excellence: UH’s Joint Replacement Program Enhances Quality and Value While Controlling Costs

When the UH Joint Replacement Program sought to enhance patient experience and ensure uniform, high quality care through its high reliability medicine (HRM) initiatives across the healthcare system, the result was safer surgery, improved outcomes, higher patient satisfaction and recognition as a national Center of Excellence (COE) by two of the largest employers in the U.S. For over 90 percent of patients, this means an overnight hospital stay, discharge to home and a faster recovery after joint replacement surgery.

As a result of the HRM initiative, UH medical centers have been recognized as value leaders for joint replacement surgery. In 2018, Walmart selected UH Cleveland Medical Center as a national COE to provide joint replacement surgery for its employees and families. Similarly, General Electric selected both UH Cleveland Medical Center and UH Conneaut Medical Center in 2016 as national COEs for joint replacement surgery.

“We have seen a dramatic increase in patient volume since the start of this innovative program,” said UH Joint Replacement and Rheumatology Institute Director Matthew Kraay, MD, Kingsbury G. Heiple MD and Fred A. Lennon Chair in Orthopaedics. “Patients participating in these programs are carefully screened to ensure these procedures are necessary, and are thoroughly evaluated and medically optimized before traveling to Cleveland for their surgery. This leads to fewer complications for the patient and provides value to employers through reduced healthcare costs associated with unnecessary surgeries and poorly coordinated healthcare.”

A multidisciplinary team at UH provides extensive education and concierge services to support the patient experience and achieve best outcomes.

A growing number of self-insured companies are contracting directly with healthcare providers for employee healthcare. The COE’s alternative payment model typically provides employees enhanced benefits, including 100 percent coverage of procedure costs and travel expense reimbursement, along with the peace of mind that comes from knowing their healthcare is provided by recognized experts.

Additionally, UH participates in Medicare’s bundled-payment program. Since 2015, UH has voluntarily participated in the program for joint replacement. And in 2018, UH began participation in Medicare’s new Bundled Payments for Care Improvement Advanced program, tying performance on quality measures and cost savings to payment for more than 10 different health conditions and surgical procedures at nine hospitals, resulting in 37 bundled payment provisions. “The experience we have gained in the joint replacement bundled payment program will be very helpful for our UH colleagues in other areas of medicine.

“By undertaking a comprehensive care redesign that included managing quality, ensuring procedures only occur when appropriate, reducing complications and readmissions, and finding more cost-effective and innovative ways to provide care for our patients in all settings where they receive care, we have not only prepared ourselves to expand our bundled payment programs, but we have elevated the standard of care in all our hospitals,” explained Dr. Kraay.