The 28th Annual Orthopaedic Trauma Association Meeting was a stage for great thinking and ideas on safety, quality and cost containment. Dr. Robert Probe’s presidential address featured Dr. Ernest Codman’s pursuit of the ‘End Result Card’ – a card devised at the turn of last century to track patients’ demographics, diagnosis, method of treatment and long-term outcome. Of course, like many good ideas involving change, it was met with arctic enthusiasm. Measuring surgeon performance was apparently frowned upon in medical circles at the time, as Ernest’s privileges were promptly revoked at Mass General in 1914 for proposing it. Monitoring and understanding the collective patient experience to improve the overall quality of care may be a norm now, but it was considered a radical idea back in those days. The End Result Card was just the beginning. Dr. Codman’s vision was for an ‘End Results System’ in which all doctors would be required to submit standardized information into a central repository that would be made available to the public.
It begs the question, if End Results Data were embraced from the get go, where would US Healthcare be now with our “big data” crunching power? Imagine measuring/observing and recording every quantifiable aspect of an episode of care for a total knee arthroscopy (TKA). Everything about the patient, the pre-/peri-/post operative care, rehab and cost would be recorded. Patterns in this data associated with optimal outcomes and the best value could be rendered. As a prospective patient for TKA, your patient information could dictate the surgeon, the time of year for your surgery and the precise impact your BMI could have on the clinical and economic outcomes. We’d be able to say with confidence that losing ten pounds prior to surgery saves $1,000 on the episode of care but only if you are a man between the age of 50 and 70 living on the East Coast. Or, waiting until spring means three fewer sessions of physical therapy if you are in a city with a population greater than one million people.
The reality we live in means the average person in Mississippi cannot board a plane for a TKA center of excellence located in New York City. But with The End Result System Data linked to computing, facilities everywhere can examine data patterns in outcomes to help improve the processes and procedures they have in place. So, that Mississippian can Uber to the hospital instead of venturing to far off cities, with confidence. And what do you know, the data just might reveal that staying local for this procedure shortens post-operative recovery by a week. Important for the patient, her grandchildren and her employer.
Dr. Codman recognized the power of good data. Thankfully, we are starting to recognize it too.
Dagen H: Putting Some Perspective On Change
Change. Turned off already, right? Not just change, but skin-crawling change. We’re not talking about warm and fuzzy, promotion at work, new luxury car, kid got into Harvard change. No. We are talking about epic, turn-daily-life-upside-down change. We are talking about potentially dangerous and catastrophic change for everyone. Enter Dagen H.
On a pleasant September 3rd, 1967, the country of Sweden switched from driving on the left side of the road to the right side. It was referred to as Dagen (Day) Hogertrafik (Right hand side traffic). The change was not made on a whim, of course, but was rather the result of 40 years of debate on the matter. Just years earlier in 1955, a national referendum on the matter actually revealed the country wanted to avoid it like the plague. Public buses needed retro-fitted doors, signs had to be changed and traffic markings had to be repainted. Yet, it had to be done. It made sense economically and for public safety as well. Forget about the opportunity for Swedish auto manufacturers to find greater production efficiencies, many Swedes were driving left-side driver automobiles on the left side of the road! The probability for head on collisions is drastically higher under these conditions. It seems unfathomable though – to change the side of the road on which traffic flows.
So what happened that day? At 5 am, for a few minutes (or more, depending on proximity to major metropolitan centers), everyone pulled over. Everyone just stopped driving. And then, police and local authorities directed drivers to switch the side they were driving on. Were there accidents that day? 126 of them, in fact. But, that happened to be 4 less than the low end of the average range and all were minor. They made the change easily with the world watching.
So with our bold yellow and black logo, much like the very street signs that guided the Swedes on that fateful Dagen H, OIC provides direction away from the nonsensical prices at the intersection of stable-technology and premium pricing where we are seemingly grid-locked. The supply chain for orthopaedic medical devices has inserted itself so cleverly into our hospitals, you’d think changing it would make any Bjorn balk. Manage the implants ourselves? Re-order the implants ourselves? No rep in the OR? For billions in savings across the country, “Exakt!” would be the response from one of our fair-follicle friends from the land of Ikea. It’s change – it’s not easy, but it’s also not that difficult either. With a little time and honest partnership, we can paint that turn to value safely. Remember, the Swedes had only ten minutes. We can do this.
Re-think what is possible. Re-think what you can do today for tomorrow. It’s a long road, but it can be a great ride if we all come together and drive on the same side of it.
What’s Your Copay On An Oil Change?
Insurance is a great thing. For virtually everything we own, there’s a policy available to protect its value or functionality. Be it your house, your car, or your health, it feels good knowing you have it. While your deductible might be something you wish you gave more thought to at the time of needing to use insurance, all in all, it can save you quite a lot of money and heartache.“Honey, toilet seat broke – what’s our deductible on that?” Click To Tweet
It seems that the way we use insurance regardless of the asset we are protecting from risk is the same – except health insurance. We don’t use our homeowner’s insurance every time something in the house breaks. Could you imagine? “Honey, toilet seat broke – what’s our deductible on that?” With every other policy we hold for protection, we go out of our way trying NOT to use it. When you smack someone’s bumper in a parking lot, the first question is always, “Can we go around insurance?”
No one walks into an orthopaedist’s office asking them to not use their insurance. In fact, if you have health insurance, you are using it as much as you can for every little thing. That is what’s gotten the fiscal train off the responsible rails in healthcare. A visit to a specialist of any kind costs several hundred dollars. But, the patient only thinks about their copay of thirty or sixty dollars for the visit. That’s hardly a number to stop them from going to the sports medicine specialist about that funny click in their ankle that sometimes happens. If the patient had to cover the total payment, there would be a lot of second guessing on scheduling a visit. More likely, said “patient” would probably spend time, not money, googling “ankle clicking home remedy” to fix that click. If we all chose to pay for that visit out of pocket, the market would correct the price very quickly by the specialists who wanted to stay in business. And, they would change the way they deliver clinical services to make it profitable and more efficient. With the cost to cover beneficiaries plummeting because of this scenario, insurance premiums would drop dramatically and coverage for larger events would be much better than what that coverage would be today for a given premium.
In using auto insurance like health insurance, an oil change would cost $500 with a $150 copay and the mechanic would tell you he wasn’t sure of the final bill until all the work was done. Furthermore, depending on your plan, the closest oil change might be a half hour from your house, given your insurer’s mechanic network. You can kiss that Groupon good-bye, that’s for sure. Want to use synthetic? That’s going to require pre-authorization and the vendor’s rep will probably swing by for that tune-up.
So what’s it going to take to fix it? Anyone living in the US can tell you it’s starting to fix itself. More and more costs are being shifted to the beneficiary. People are starting to choose medical services and providers based on cost. We’re not ripping off the Band-Aid quite yet, but there will come a day when we look back and laugh at the fact that coupons for a total knee weren’t available online.
This post was contributed by Othopaedic Implant Company