Healthcare has evolved in recent years, becoming more sophisticated and technologically savvy to meet today’s value-based goals and deliver on patient-focused promises. Unfortunately, many hospitals are still constrained by limited resources, making it impossible to fully meet the demands of value-based care.
According to American Hospital Association, the total spending for our U.S. hospitals is over $1.2 trillion, and that doesn’t include ambulatory surgery centers, clinics, physicians or specialty practices. The United States has the most expensive health care system in the world, but a significant portion of that spending is considered wasteful. Recent research suggests that wasteful health care costs range from $600 billion to more than $1.9 trillion annually, or roughly $1,800 to $5,700 per person per year.
There is a heightened sense of urgency to address the healthcare waste problem as our aging population and their corresponding healthcare needs skyrocket. By 2030 1 in 6 people in the world will be 60 years or more, and our already overtaxed systems will be forced to take on even more. Especially for the Medicare population, orthopedic diagnoses and musculoskeletal (MSK) procedures are set to become a leading driver of healthcare spending. As these trends increase, so does the need to find efficiencies and eliminate wasteful spending across the continuum of orthopedic care.
Cost Drivers in Orthopedic Care
Expensive revision surgeries and out-of-network care can be seen as obvious culprits when it comes to cost drivers and where we can find efficiencies. But as technology, guidelines and care protocols advance, they are the rare exception rather than the driving factor behind the increased costs of orthopedic care.
Unnecessary care is often an overlooked cost culprit.
Care providers at MSK face challenges related to value-based care every day, but eliminating redundant care can immediately reduce costs with zero impact on quality of care, improve patient experience, and even lead to positive profits with its partners in the MSK care continuum: insurance providers and hospitals.
The problem of excessive care
A musculoskeletal patient will likely engage with several providers during their diagnostic and treatment journey, from surgeons and physicians to hospitals and rehabilitation centers, each with their own respective protocols, electronic medical record (EMR) system, online portals and methods to track patient information. This same patient may experience redundant care by being required to obtain multiple sets of radiographs when only one is needed because the images are not available from every provider, in every EMR, or online portal. Although cuts occur in a myriad of different ways, this example shows how easy it is for a misunderstanding or a lack of coordination to drive up costs.
The exact costs associated with excess care vary widely because they fall into different categories wasteful spending categorieseach with their own varied descriptions, including:
- Failures in care coordination
- Inefficiently delivered services
- Lack of coordination of care
In addition to a lack of data interoperability, communication, and alignment among care providers, the biggest barrier to reducing or eliminating layoffs is an internal sense of mistrust between each group—to the point where each believes the other is not values what they do or have already done.
Mistrust only grows when you speak or understand the language differently – which is often the case with providers, hospital systems and insurance companies. In this case, the language is ICD-10 codes, protocols, and guidelines. We can address this barrier of mistrust and solve the problem of redundant care in two key ways: comprehensive, interoperable data exchange and stakeholder alignment around highly reliable, data-driven clinical care pathways and a coherent model of stimulation.
The low-hanging fruit of waste elimination
No matter where you are on the continuum of care, interoperability is known to be essential to both improving patient care and advancing value-based care initiatives. Actually, a recent one report on interoperability from CHIME and KLAS Research shows that over the next three years, provider organizations look forward to steady improvements in patient record exchange and population health.
Beyond engaging an EMR vendor, one immediate step that orthopedic care providers and health systems can take toward interoperability is through the adoption of a health information exchange (HIE). A healthcare network enabled by HIE solutions, standardized care pathways, and organized protocols would effectively facilitate the rapid exchange of information between a patient’s orthopedic team from the beginning of treatment to the end of care, helping to reduce the cost of care while improving outcomes .
By building on the foundation and principles of information sharing, the health network can further reduce redundancies by aligning both shared data and stakeholders involved in the continuum of orthopedic care. For individual institutions, providers and health systems, information sharing and true stakeholder alignment may seem impossible, but by bringing in a strategic partner with skills in both, it is an achievable goal.
A strong platform should bring all stakeholders together, reduce variation and drive standardization of care. Implemented within their growth and cost savings plans, orthopedic healthcare providers using such a partnership should not only improve their operational efficiency, financial performance and clinical outcomes, but also increase their market share as patients and MSK professionals gravitate toward these highly effective programs.
Redundancies happen, but by using the most advanced analytics and EMR-agnostic decision-making tools available, orthopedic care providers can positively influence hospital staff decision-making, reduce redundancies, and make progress in reducing costs, which ultimately results in profit for our patients.
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