With the industry’s focus on value-based care, musculoskeletal service line leaders responsible for transforming processes and programs must be responsive both to payment reform and to the increasing expectations of healthcare consumers for ease and convenience. Everyone’s sights are set on delivering better outcomes, greater patient satisfaction, and lower costs.
The 2018 Musculoskeletal Leadership Summit brings orthopedic and spine thought leaders together to share best practices and lessons learned, presenting a unique opportunity to provide orthopedic and spine program excellence without the need to reinvent the wheel.
In Part Five of our series, we spoke with Dr. James M. Weiss, President, Orthopedic Surgery at the Orthopedic & Sports Rehab Center, about his top strategies for patient-centered care.
Tell us about your background in orthopedic surgery. How has the shift to value-based care and the increasing expectations of healthcare consumers influenced the work that you do?
I did my orthopedic residency in Baltimore and then I did a fellowship in shock trauma for three months. From there, I went into private practice at my present location. I consider myself to be a general orthopedist, although I have specialty areas in spine surgery and sports medicine joint replacement. I am also the president of a company that engineers tissue for joint replacements.
Some of the hospitals where I practice are trying to streamline their service lines in anticipation of mandatory bundles under Medicare. Some aspects of the Comprehensive Care for Joint Replacement program were going to be mandatory, but the administration has pushed that back so it will be elective. That may or may not change, no one really knows. And that may or may not become academic, depending on whether more of the private payers push for that.
Once groups become geared for doing bundled payment plans, that service line tends to take over their practice, because the entire practice has to be oriented towards those patients. Essentially, whether you’re in the bundled payment plan or not, depending on your insurance, you then become put into their protocol or their algorithm for bundled payments. It would be extremely difficult for a practice to have two separate service lines – bundled payment and non-bundled payment. It’s inefficient to have your staff figure out whether this person is in or out of the plan, and it would likely be more expensive than just converting the entire practice.
As you know, the 2018 Musculoskeletal Leadership Summit presents an opportunity for service line leaders to connect and participate with surgeons and other clinicians. Why is this type of collaboration important for clinical transformation?
In order for one to present a seamless experience for patients and surgeons alike—and those two different aspects of care are really one—it’s always good to have open lines of communication. Whether it’s the surgery center, hospital, or outpatient clinic, there should be some individuals who are able to take the 10,000-foot perspective and assess the patient experience from when they enter the facility to when they complete their episode of care.
If you’re not taking into account the different stakeholders in that process—the hospital, the payer, or the service line providers—I think you’re missing out on opportunities for efficiency, whether that’s economic efficiency or the efficiency of provided service – and they eventually go hand-in-hand.
There needs to be coordination amongst the entire team, because it should be considered a team effort. That may not lead to complete agreement, but it’s certainly going to lead to openness for the discussion. And this is how you develop an understanding between the different stakeholders in the entire process.
This open communication can only lead to positive things. It may not lead to complete agreement. It may lead to compromises; but at least everyone understands where each individual is coming from.
Can you tell us a bit about your speaking topic, “Orthopedic Surgery Past, Present, Future: Inpatient/Outpatient/No patient”? Why is this topic important to you personally?
Most of orthopedic care is non-operative care. What I mean by that is most of the patients who have seen your office don’t require surgery – they require conservative care, although conservative occasionally is surgical care, but most of the time they do not need operative intervention.
If you’re a typical orthopedic surgeon, you’re providing operative and non-operative treatment. It would be hard to provide all of those in the present environment – whether that environment has changed significantly in the past 10 to 20 years is all from your individual viewpoint.
When it comes to the topic of what has happened in the past, there’s the saying “the past is prologue.” It’s always good to know where you’ve been; it helps to define where you’re going. The topic of where we’ve been, and where we are, and where we might be going, is helpful to surgeons, providers and service line people because, again, they should all try to be aligned with each other. They may have slightly different motivations and different perspectives. But everyone is really after the same goal: to provide timely, efficient, and high quality patient-oriented care.
Can you share some examples of the work you’ve done to improve experience, outcomes and value of orthopedic surgical care at The Orthopaedic & Sports Rehab Center?
How you define value depends on your viewpoint. Providing value to patients is really patient specific, because what is valuable to one patient is not necessarily the highest order of focus to another patient.
What we try to do here, at least philosophically, is take each individual patient one at a time, and sit and listen to them. We try to understand what it is that they’re presenting for, and what their issue is orthopedically. We try to take the entire viewpoint of where the patient has been, whether or not they have had other treatments – successful or otherwise. And what exactly is their goal, what are they looking for? What is the lack of function that impedes their daily enjoyment of life, and what has brought them into the orthopedic office – whether self-initiated or referred by another provider?
Providing value to patients is really oriented to what the patient considers valuable, because that could cover many different things. Some patients may be looking for providers who participate with insurance because one of their man focuses is cost, whereas other patients may not have that issue. Other patients may have had less than optimal experiences at other places, or have not been able to get a diagnosis, or have had other failed treatments.
The way the team at the Orthopedic & Sports Rehab Center provides value is we try to understand what the patient’s needs are and what they’re looking for. This has been the road to our success over the last 25 years.
What about the Summit are you most looking forward to?
I’m looking forward to the opportunity to interact with other individuals from different areas of practice. There are limited opportunities for a busy orthopedic surgeon to speak and have an interaction with other healthcare providers that is not timeline-oriented.
When I go to the Academy meeting, I see lots of other orthopedic surgeons, but I tend to be running from place to place to get to lectures or presentations. This is a nice opportunity to have an open discussion and interaction between different levels of care providers in an intimate environment. It’s not just going to be me speaking on a highly technical area with other orthopedic surgeons about a really focused subject. I’m looking forward to having a more general discussion with other individuals and hearing what their viewpoints and concerns are.