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COVID-19 has significantly disrupted the orthopedic industry. As seen in Figure 1, DocSpera observed the nearly complete halt of elective surgeries in mid-March across the United States as a result of the stay-at-home orders and mandatory surgical cancellations.
Once elective surgeries were permitted to resume by state governments, surgeons were forced to grapple with a huge backlog of patients who had their surgeries cancelled as well as the regular flow of new patients who also were in need of surgery. When combined with the fact that many practices had to lay off large portions of their administrative staff, the problem became practically unmanageable.
Since that time, DocSpera has observed a fundamental change in the statistics of how orthopedic surgeries are being booked, which has significant implications for not only surgeons and their patients but also medical device manufacturers and healthcare systems at large.
Most notably is the reduction in lead time across the United States. Lead time is defined as the difference between the surgery booking date and the actual surgical date. To control for the anomalous nature of the first two months of the pandemic in which the state-mandated surgical cancellations occurred, March and April of this year were taken out of the analyses. Additionally, to ensure sample sizes were the same for comparisons, an equal number of months were selected for pre and post COVID-19 groups: 11/2019 to 2/2020 for Pre-COVID and 5/2020 to 8/2020 for Post-COVID. Medians were used as averages instead of means because the data were highly positively skewed. As seen below in Figure 2, a majority of the cases were concentrated towards smaller lead times.
In the months leading up to the outbreak of COVID-19, orthopedic practices using DocSpera were reporting a national median lead time of 20 days. In the most recent few months, lead time has decreased to 13 days. Figure 3 below displays the average lead times broken down by state for a more granular picture of the changes across the country.
On top of this, cancellation rates seemed to have increased about 2% as previously shown in Figure 1. These differences cannot be explained by insurance or other administrative related issues as these would have existed before the pandemic. Additionally, the biased first months of mandatory cancellation were removed so this data indicates that the industry is truly seeing a “new normal” where surgical lead times are shorter and cancellation rates are higher than before the pandemic began. The most likely explanation for this is a combination of patients’ fear to undergo surgeries during this crisis and schedulers uncertainty of the future, leading to orthopedic practices only booking cases about two weeks in advance.
To address this ongoing uncertainty and increased administrative burden on orthopedic practices, DocSpera has built the Intelligent Scheduler, a tool that allows surgeons and schedulers to effectively re-prioritize their patients at scale. Patients are sent intake surveys to collect pertinent information such as their availability, pain and narcotic usage, functionality, fall risk, comorbidities, and COVID-19 exposure. This data is then outputted in an interactive dashboard, where surgeons can pick from a selection of automated prioritization algorithms and sort their patients accordingly. This information can then be used while rebooking patients to ensure that those who need surgery the most are scheduled the soonest.
As elective surgeries are being rescheduled across the nation, in-home physical therapy is helping physicians manage pain and engagement levels within their patient populations. Physicians in major metropolitan cities like San Francisco, Los Angeles and Chicago, are increasing referrals for in-home PT. In response, DocSpera has enabled one-click PT referrals for all patients who are geographically covered in those service areas at no cost.
Until recently, it wasn’t uncommon for patients to leave their homes and travel to their physical therapists for treatment. COVID-19 has changed the ability to continue doing that thanks in large part to travel restrictions and closed businesses. In-home physical therapy has been able to circumnavigate these pitfalls by minimizing patient travel and the need for public interactions. Therapists within the in-home referral program take precautionary measures before each home visit and follow CDC recommended guidelines for infection control. As a result, physicians looking to manage patient comfort and engagement in the interim are using in-home PT as an effective tool to keep one of the most vulnerable segments of our population safe.
During these disruptive times, it’s clear that physicians don’t want their patients to suffer additional pain as they wait for their rescheduled date to come. DocSpera’s one-click referral solution is giving physicians a new option to keep patients safe, engaged and happy.
With no sure solution in sight, a new method of patient care is attempting to adapt to the existing environment.
Finding a four-leaf clover in a 10-acre field might prove easier than finding someone who isn’t yet fed up with robocalls. By some reports, nearly 50 billion robocalls were placed in 2019 alone. While that phony credit card call might seem like a minor nuisance when it happens at the individual level, the impact is magnified when it happens to practices, surgery centers and hospitals.
According to the Washington Post, Tufts Medical Center received over 4,500 calls in a 2 hour period on April 30th, 2018. That’s about 1 inbound robocall every 1.5 seconds. However, since this is a medical center, these calls can’t just be ignored. Staff members need to pick up each call in the event there’s a real human on the line in need of assistance. This not only wastes worker resources, but it also creates a scenario where a caller in need of assistance might face a busy signal for hours.
At the same time, robocalls have conditioned patients to ignore calls from numbers not stored in their phones. A medical specialist attempting to schedule a visit for a referral from a primary physician will likely be initially ignored. Even if a voicemail is left on the patients answering service, it’s not guaranteed anyone will listen to a message from an unknown number. This can then lead to delayed communications or missed appointments and reminders.
Congress has tried for years to find a solution without much luck. Recently, the TRACED Act was passed by both houses and signed into law on December 30th, 2019. It essentially places the burden of stopping robocalls on the shoulders of phone carriers, while giving the FCC some extra teeth in fighting offenders. Some believe the call scam will evolve to circumvent these new laws or robocall centers will move to countries outside of US jurisdiction.
A recent solution in the market attempts to limit the negative effects of robocalls by essentially adapting to their existence. Patient Automated Texting (PAT) is a solution that leverages the findings from a recent study in the Journal of Bone and Joint Surgery (JBJS). Rather than depending on human staff members to remind patients of upcoming visits, check in on a patient’s progress, or answer a phone call regarding a common question, PAT redirects those tasks to a smart text messaging service instead. The service keeps patients on track with adherence and also provides answers to commonly asked patient questions. Essentially, PAT channels patients away from phone call communications and limits the need for unimportant staff interactions.
PAT can be viewed as a solution that eliminates a significant amount of call volume, both inbound and outbound. As a result, a practice’s reliance on phone calls as a primary means of communication is lessened. The burden is shifted to text messaging capabilities to handle the more common questions asked of patients. It’s key to point out that phone calls can be ignored, but text messages are typically reviewed by their recipients. While PAT won’t stop robocalls from happening altogether, it will ensure a patient’s care path is followed even when staffing resources are stretched thin.
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For those unfamiliar with the term, risk stratification is simply the process of identifying high risk patients, or those likely to be of high risk, from a patient population. The general theory is that by identifying high-risk patients before surgery, physicians and care teams can either take actions to minimize possible complications, or they can postpone the surgery altogether until existing risk factors have been reduced.
Currently, the healthcare industry uses a number of different methods to stratify risk based on a number of different reasons. Some, if not all, may sound familiar. They include: Charlson Comorbidity Measure, BMI, Hierarchical Condition Categories, Elder Risk A, etc. Reviewing actual historical data can also provide a significant contribution to the overall assessment. Each option has its own merits.
Much like the idea behind diversifying a stock portfolio, DocSpera realized that combining a number of these methods into a single solution would likely yield more reliable and consistent outcomes. As a result, DocSpera recently introduced a risk assessment tool that automatically calls out a high-risk patient based off of the combined results of a number of risk assessment tests. It goes on to explain what metrics were used to get to that conclusion, and the level of confidence behind its assertion. All the information analyzed for the assessment is instantly gathered from a combination of real-time sources such as EMR data, available patient social determinant data, CMS data, and patient reported data.
The net result is a unique statistical metric that physicians and care teams can reference to aid in their overall patient care decisions. Using a combination of data points, the goal is to minimize complications and improve the outcomes for a given patient population.
Dr. Robert Mayle wanted to improve upon his existing surgical care coordination workflow at his clinic. His team relied on physical paperwork, faxes and emails to fill out and send surgical booking sheets to his surgery locations. He understood the drawback to relying on this older technology was the potential to overlook, misplace or even lose paperwork containing critical information for the patient’s surgery. In turn, this could cause delays inhibiting his quality of care for the patient and even add a cost to rectify the situation. This didn’t sync with CPOSM’s mission to provide a superior level of healthcare in a compassionate, efficient and cost-effective manner.
Dr. Mayle overhauled the manual process of copying information from the EMR to the surgical booking sheet by replacing it with a digital solution. Via the DocSpera integration to his EMR, he was able to pre-populate his booking sheets with all the patient information already in the system. The digital booking sheet would then be signed with a couple clicks of his mouse and automatically sent to the surgical location. The transfer was automatic and completely digital using DocSpera’s HIPAA-compliant platform.
When all was said and done, Dr. Mayle had reduced the time it took to complete the surgical booking sheet, eliminated the need to fax or email anything and maintained the privacy of his patient’s PHI. His entire care team now had access to the same information at the same time.
California Pacific Orthopaedics and Sports Medicine is the San Francisco Bay Area’s leader in the diagnosis and treatment of orthopedic and sports-related injuries, including injuries to the knee, shoulder, elbow, hip, spine, hands and feet, as well as trauma, arthritis and work-related injuries. CPOSM team of nationally recognized surgeons offers the most advanced treatment and the latest technology in the field of sports medicine.
Driving Sterilization Cost and Surgical Case Cycle Time Reduction
New payment initiatives such as Bundled Payments for Care Improvement (BPCI) as well as increased volumes in joint replacement surgeries are putting pressure on the need to reduce hospital costs for surgical procedures. Under the BPCI initiative, organizations enter into payment arrangements that include cost and performance accountability for episodes of care. In addition, OR on-time start and case cycle time are becoming critical in effectively managing the increase in surgical case volumes in Hospital ORs. Web-based coordination platforms that integrate with existing EMRs have shown promise in reducing OR sterilization costs and surgical case cycle time. By linking practices, hospitals and medical device vendors on a common platform, early collaboration on pre-operative surgical cases can help better meet BPCI goals while driving performance accountability through quality of care.
The focus of the study was to measure the reduction in pre-operative planning time, instrument sterilization time & cost, and case cycle time across pre-op and post-op. The study provided the surgical practice team, hospital OR team and vendor with an integrated HIPAA compliant surgical case coordination platform to drive better planning of implant and instrumentation for upcoming surgeries. Cost and time reduction could help drive BPCI financial cost goal while maintaining and enhancing patient care.
The study was done at Medical Center of Arlington in Arlington, Texas. The platform chosen for the trial was DocSpera, which allowed for surgical scheduling, pre-operative case planning and x-ray sharing with the OR team prior to surgery. For the study, Dr. Shane Seroyer, Medical Director and Orthopedic Surgeon focused on joint replacement – hip and knee replacement and revisions. He used DocSpera for pre-operative planning of all joint replacement surgeries. He worked with pre-operative nurse, physician assistant, material manager, sterilization manager and medical device representative on DocSpera’s platform to prepare upcoming surgical cases and drive advanced case visibility with the team. All members of his care team had access to DocSpera and were able to view all upcoming cases and templated x-rays to determine the type and size of implant required on average 3-4 weeks prior to surgery versus 5-7 days before.
As part of the study, the team recorded the baseline of trays used per case and case cycle time across pre-op and post-op. For the first part of the study, conducted from August 2015 to May 2016, the team deployed DocSpera without any process changes. For second part of study, the team introduced instruments configuration based on upcoming case volumes and templated sizes visible in DocSpera to drive tray reduction.
The advanced visibility and planning enabled by DocSpera, and subsequent configuration of instruments needed for specific cases, led to a reduction of trays brought to each surgical case from 13 down to 3 trays. By lowering the number of trays being used per case, the team was able to reduce the number of trays sterilized per case and decrease pre & post cycle time by 76% and 71%, respectively. The team was able to also reduce the amount of time it took to prepare instruments from the tray and assemble the instruments back in the tray for cleaning. This further led to a reduction in the average number of staff required to prepare and remove trays from 2 individuals down to 1.
In addition, fewer trays per case created significant space savings within the OR; the team reduced their use of tabletop space by 50% (from 6 cu ft. to 3 cu ft.), making it easier to operate in a smaller OR.
DocSpera proved to be a major driver of efficiency during the study. From improved coordination between various surgical event providers, reduced administrative time required to book and reschedule cases, better visibility and communication regarding necessary surgical instruments, and time and space saved through the elimination of unnecessary materials, DocSpera delivered significant savings to the team over the course the study.
While efficiencies were pursued within the operating room suite, and many of them had to do with common objective projects, it was clear that utilizing DocSpera was one of the major drivers of efficiency.
DocSpera, the leading surgical care coordination platform, has partnered with the Centers for Medicare & Medicaid Services (CMS) to bring Blue Button 2.0 to medical providers on the DocSpera network. With Blue Button 2.0, providers now have the opportunity to access four years of Medicare Part A, B & D data for an estimated 53 million beneficiaries. The information includes drug prescriptions, primary care treatment and cost, and Medicare coverage details. A full list of available data can be seen here. This feature empowers surgeons to improve surgical outcomes while lowering the costs. Data history enabled by Blue Button will facilitate communication between patients and healthcare providers, speed up diagnosis and treatment as well as drive decision support.
Blue Button is a big step forward in patient care collaboration and coordination. It lets patients, providers and software services use the vast, yet often difficult to access, patient health data to drive improved healthcare outcomes. Through DocSpera’s new partnership with Blue Button, patients can now obtain their personal health information and share it with a specific healthcare provider of their choice for a more personalized level of care.
“DocSpera’s partnership with Blue Button is another example of how we improve surgical episode transparency and continue to strengthen patient risk stratification for our surgeon customers to deliver improved and more customized patient care.” said Sy Fahimi, CEO of DocSpera.
By enabling Blue Button, DocSpera is allowing its surgeon members to access the patient consented medical history data to share and power improved risk stratification through DocSpera’s decision support platform. Integration of Blue Button, along with the episodic data captured within DocSpera’s platform, allows the company to provide insights and analytics to empower surgeons to make better decisions via accurate data and therefore save time and reduce cost while improving the quality of care.
Patients in parallel, will have access and control over their health care data as well as benefit from a faster, better and more cost-effective care.
“We are able to offer comprehensive, automated and instant solution for our surgeons to see their patient’s medical and medication history before their surgical consultation; our current BlueButton integrated pilots have demonstrated significant value for our users” stated Samuel Ethiopia, COO of DocSpera.
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Great tips to keep your practice data secure and avoid data, PHI or security breaches.
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