Total Joint Replacement Program Remains on Top through Innovation

Outpatient procedures, Centers of Excellence status help meet demands of employers and insurers alike

Innovations in Orthopaedics | Winter 2021

The move toward value-based care has motivated healthcare providers to innovate care delivery to shorten length of stay and exceed previous quality benchmarks. Refining established processes to meet those goals has paid off especially well during COVID-19, when patients demanded a more efficient and safer surgical experience.

This drive to provide convenient, efficient, high-quality care is evidenced in the University Hospitals total joint replacement program. With its focus on wellness and safety — as well as value and patient satisfaction — UH has one of the top joint replacement surgery programs in the country.

UH’s reputation for quality and outcomes caught the attention of General Electric, which selected both University Hospitals Cleveland Medical Center and University Hospitals Conneaut Medical Center to be part of the Employers Centers of Excellence Network (ECEN) for joint replacement surgery. Then, in 2018, one of the world’s largest retailers welcomed UH Cleveland Medical Center as a national Center of Excellence.

“Contigo Health is proud to work with University Hospitals and its clinicians and staff,” said representatives of Contigo Health, which administers the program for the retailer. “University Hospitals and its physicians undergo Contigo Health’s thorough and iterative evaluation process. Selection is made through an invitation-only request for information and leads to an extensive review of quality, outcomes and patient satisfaction data. Fewer than 5%* of healthcare systems initially identified for participation in Contigo Health ECEN Passport™ meet all of the quality requirements for consideration”

 Matthew Kraay, MD

“A growing number of large corporations, like GE and Walmart, recognize the benefits of contracting directly with high-performing programs for their employees’ specialty care,” says Matthew J. Kraay, MD, MS, Director of The Center for Joint Replacement and Preservation, and the Kingsbury G. Heiple and Fred A. Lennon Chair in Orthopedics, UH Cleveland Medical Center and Professor of Orthopeadics at Case Western Reserve University School of Medicine. “They know their employees will receive safe, high-quality, cost-effective care. Even when employees have to travel for care, both employers and patients benefit due to reduction of complications, readmissions, reoperations, and often times earlier return to work.”

FROM ADMISSION TO DISCHARGE IN 24 HOURS

Over the past 10 years, UH Cleveland Medical Center has reduced its length of stay for hip and knee replacement surgery from four days to one day or less. “This was accomplished using a large multidisciplinary team to develop a program infrastructure that allowed patients to go home the same day of surgery,” says Steven Fitzgerald, MD, Director, Adult Reconstruction at University Hospitals and Assistant Professor of Orthopaedics at the School of Medicine. “Delivering high-value care for our patients was our motivation, while our consistency of care, accelerated rehabilitation program and multimodal pre- and post-op pain program make it possible.”

 Steven Fitzgerald, MD

When patients go home sooner, they don’t receive less care. They receive comparable care at home. That care starts with thorough patient education and screening and assurance UH clinicians and physicians will be with them every step of the way, regardless of environment.

“Maintaining close contact for the first three weeks after surgery is critical,” Dr. Fitzgerald says. “We accomplish this by creating multiple points of contact for our patients through our navigators, extenders and our digital platform.”

Once a patient schedules surgery, the preparation process begins with engagement by a UH patient care navigator. Pre-operative screening includes making sure patients have a safe, manageable home environment and a care partner to support the patient through the surgical episode.

“We use several digital tools to stay connected with our patients and walk them through a comprehensive surgical episode of care,” Dr. Kraay says. “Our mobile app guides them through the steps they need to take, starting 45 days before surgery and extending until they are recovered from surgery. Both pre- and post-operatively, our patients have online access to instructional videos, a pre-op education class, a ‘pre-hab’ exercise program and virtual physical therapy. We are readily available to our patients via secure health messaging 24/7 to answer questions they may have.”

While UH Cleveland Medical Center implemented its patient engagement/telehealth platform to benefit all its joint replacement patients, it is a critical component of the Centers of Excellence programs. Because many of these “travel surgery” patients come to UH Cleveland Medical Center from outside Northeast Ohio, preliminary health and risk assessment, determination of appropriateness for surgery, and preoperative optimization for surgery take place virtually — often months before surgery.

“Patients are truly incentivized to improve their health before surgery,” Dr. Kraay says. “We help them address modifiable risk factors for complications such as smoking, poorly controlled diabetes, hypertension and obesity. Although this may delay surgery, these patients are incredibly grateful for our focus on their health, wellness, a safe surgical experience and the concierge level of care they receive.”

Because of the COVID-19 health crisis, many companies put a freeze on their travel surgery programs. The UH Centers of Excellence programs resumed in June; however, patients have to travel by car and follow all COVID-19 testing and safety protocols.

No matter how far patients travel, the UH joint replacement team provides the same quality of care during their stay, as well as makes sure they get home as soon as possible. “We’re constantly looking at ways to improve the quality of care for our patients and to stay at the forefront of TJR at the same time,” Dr. Fitzgerald says. “We look forward to making patients’ lives better.”

To find out more about the University Hospitals total joint replacement program or to refer a patient, call 216-352-0823.

*Jonathan R. Slotkin, MD, Olivia A. Ross, M. Ruth Coleman, Jaewon Ryu. 2017. “Why GE, Boeing, Lowe’s, and Walmart Are Directly Buying Health Care for Employees". Harvard Business Review. https://hbr.org/2017/06/why-ge-boeing-lowes-and-walmart-are-directly-buying-health-care-for-employees