Sign Up for ORTHOPRENEUR news & articles

Choose one or more mailing lists:
ORTHOPRENEUR Advertising Opportunities
ORTHOPRENEUR Product Updates
First Name:
Last Name:
Email Address:
Business Name:
Industry        Surgeon

Your privacy and data is important to us and we will never sell or use your information for any purpose other than stated.

The Change Management Project: One Surgeon’s Attempt to Fix a Hospital Orthopaedic Service

Posted in Surgeon as Entrepreneur | Mar 2013 | Comments (0)

Tags: Editor's Choicepatient protection and affordable care actorthopaedic surgeonhealth care reform billevidence based medicinegovernment regulation

Blair Rhode, M.D. has begun a journey to reform his hospital's orthopaedic department. He brings a unique perspective, in that he owns his own orthopaedic practice (100%), his own surgery center (100%) and his own orthopaedic implant company (100%). He approaches his job from the singular perspective of providing the very best product at the very best price. He understands that quality and efficiency arise out of process. But he also realizes that process for the sake of a bureaucracy begets a race to the bottom for quality and unrestrained cost.

This is the first entry into a series of articles about implementing and managing changes by a small group of participants in orthopaedic services at a community hospital. We will see if the efficiencies perfected in a single specialty surgery center can be applied to a small hospital.

The president went on record in 2009, stating that Obamacare was going to save the typical family $2,500 in premium costs. He also said in an April 2011 speech on fiscal policy that the reforms in the healthcare law would “reduce our deficit by 1 trillion dollars.”

That was then. This is now.

In January, Forbes stated that premiums have increased by an average of $3,065. Mark Bertolini, the CEO of Aetna, has said that some premiums are going to rise 100%.

The president’s hand-picked health policy experts claimed that improved care coordination, investment in information technology,and more efficient marketing through exchanges would result in the savings. The reality is that most of the Congressional Budget Office’s (CBO) cost-reduction has resulted from taking money out of Medicare in the form of lower Medicare payment rates. True to “kicking the can” form, Congress has undone most of the Medicare cuts.

The Patient Protection and Affordable Care Act is more than 2,400 pages of cumbersome regulations, intrusive mandates and red tape. It has created approximately 159 new committees, agencies and programs with phrases such as “patient centered outcomes research, value based payment modifier and the quality reporting initiative.” The Independent Payment Advisory Board (IPAB) will emphasize comparative effectiveness research to determine approved therapies. This is based heavily upon the British National Institute for Health and Clinical Excellence (NICE). NICE utilizes a complicated mathematical formula to limit care such that Britain will not spend more than $22,000 to prolong life by six months. This has resulted in survival rates for breast cancer and prostate cancer of 69.7% and 51.1%, respectively, compared to survival rates in the United States of 83.9% and 91.9%, respectively.

The act also requires the physician to regularly submit information on quality care administered and if “the eligible professional does not satisfactorily submit data on quality measures for covered professional services for the quality reporting for the year, providers will face a penalty.” This will serve as one more task for physicians to focus on other than their patients.

A good example of this bureaucracy in action is the Surgical Care Improvement Project (SCIP). Initiated in 2006 by CMS and the CDC, the SCIP partnership is coordinated through a steering committee of ten national organizations. The stated goal is improving the safety of surgical care through the reduction of postoperative complications. But measures are often rolled out without consideration of their full impact, causing confusion, frustration and possibly patient harm. The institution of SCIP has markedly increased the compliance to its measures, but study after study show that it provides little to any substantial benefit to patients, whereas this improved compliance comes at the cost of significant time, money and staff resources.1,2,3,4,5,6 Not one of these six referenced studies achieved improvement in their stated outcome measures.

Add comment

Security code