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In this short video, UPMC orthopaedic surgeons MaCalus V. Hogan, MD, MBA, FAAOS, FAOA; Brian Klatt, MD, FAAOS; and A.J. Yates, Jr, MD, FAAOS, FAOA; along with Amy Helwig, MD, MS, chief quality officer and vice president of Quality Improvement and Provider Performance at the UPMC Health Plan discuss the development and implementation of the Hip and Knee Joint Replacement Surgery Center of Excellence Program.
Hip and knee joint replacement surgeries are some of the most frequently performed in the United States. The Centers for Medicare and Medicaid Services (CMS) reports that upward of 400,000 procedures were performed in 2014, resulting in excess of $7 billion in care costs. CMS estimates the average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas, with postsurgical infections or implant failures contributing to these costs. CMS also estimates that complication and readmission rates can be three or more times higher at some facilities versus others.
The number of hip and knee joint replacement procedures stands to rise dramatically over the next decade, with estimates varying between nearly 200 to 700 percent. Data also points to a significant uptick in revision surgery as the population ages. Although these procedures are common, there is significant variation in medical costs, provider quality, and the patient experience. For these reasons, UPMC sought solutions to give patients greater access to facilities that provided higher quality outcomes and a better patient experience.
Prior work and implementation of collaborative care models at UPMC helped to establish value-based programs focused on primary care and joint replacement surgery across western Pennsylvania, providing foundation for future program development.
Early pilot programs, robust data and analytics platforms, and UPMC’s composition as an integrated delivery and finance system facilitated the conversation around best practices, quality improvement, and value-added practices on both the provider and payer sides of the system.
With the 2016 launch of the CMS Comprehensive Care for Joint Replacement (CJR) model an opportunity was created for UPMC to further expand payer-provider collaborations. UPMC orthopaedic surgeons partnered with UPMC Health Plan to administer a bundled payment and quality incentive program for joint replacement resulting in the majority of patients being covered by a value-based program. This model accelerated clinical transformation, rapidly decreasing quality variations, including complications and readmissions. It underscored the importance of placing financial accountability and incentives for the episodic cost and quality across the spectrum of care. All of our CJR-mandated hospitals have been successful in the program.
In August 2019, the UPMC Health Plan established a Center of Excellence (COE) program for elective hip and knee joint replacement surgery to improve quality and reduce variation. Developed in collaboration with the University of Pittsburgh Department of Orthopaedic Surgery and affiliated community surgeons, the new program recognizes surgical facilities and orthopaedic surgeons that demonstrate high quality outcomes, low complication rates, and the best patient experience for UPMC Health Plan members in need of joint replacement surgery.
Orthopaedic surgeons and hospitals in this program have established patient-centric, evidence-based care pathways, as well as an outcomes-based quality improvement program. To be eligible, both hospitals and orthopaedic surgeons must demonstrate a high performance level that results in an optimal patient experience throughout the entire care process — from shared-decision making, to helping patients understand all their options (including nonsurgical alternatives), toward recovery and return to full functional lifestyle.
Nine hospitals are currently participating and more are likely to follow. The program is open to any hospital in the UPMC Health Plan network that meets a robust, but achievable, set of requirements.
Learn more about the Center of Excellence program for hip and knee replacement surgery by visiting upmchp.us/hip-knee-coe.