Atlantic Health System has taken a new approach to care for patients who undergo hip and knee replacements, and the changes have led to positive outcomes and cost savings.
The integrated healthcare delivery system has six hospitals in the New Jersey area and four of them—Morristown Medical Center, Overlook Medical Center, Chilton Medical Center, and Newton Medical Center—participated in the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement (CJR) model.
Under the model, launched in 2016, CMS reimburses hospitals that perform hip and knee replacement surgeries based on patient outcomes instead of how many surgeries were performed. The Atlantic Health System team decided to redesign the way they care for patients who undergo hip and knee replacements, from the time the patient and doctor make the decision to proceed with surgery through recovery, according to Steven Maser, M.D., medical director, Orthopedic Surgery, Atlantic Health System.
“By taking a critical look at what a patient needed and working in tandem with the patient’s family and all of the medical professionals involved in care—nurses, surgeons, patient care navigators, skilled nursing facilities/rehabs and at-home nursing care—we were able to develop a new model that streamlines care to ensure quality, and is more efficient. We are incredibly proud of this,” Maser said in an announcement.
Among the organization’s most significant changes: sending appropriate patients home to recover instead of to a rehabilitation or skilled nursing facility.
Initial data showed that the system's hospitals frequently sent patients to skilled nursing facilities after the procedure. And the data also showed that patients with the same number of chronic conditions who had their hips and knees replaced in 2012, 2013, 2014 and between April 1 and Sept. 30, 2016, were more than twice as likely to return to the hospital within 90 days after surgery if they were admitted to a rehabilitation or skilled nursing facility rather than being discharged to home.
The team decided to implement a risk assessment model to ensure patients deemed able to go home did so with proper postoperative support and resources. Under the system’s new model, there was a 117% increase in patients discharged home.
“We know that patients who recovered at home were happier in the comfort of their environment, moved more because they were familiar with the space, had less exposure to germs from other patients and would simply save money by not unnecessarily going to a skilled nursing facility,” Maser said.
Overall, this change in process yielded an average decrease of 6.7 hospital/skilled nursing facility days and nearly $4,000 cost savings per patient episode, according to the system. And the Morristown Medical Center received the second highest reimbursement in the country for its year one performance in the CMS program.
Additional best practices under the system’s streamlined care coordination model include:
- The creation of a systemwide standard of care for all CJR patients—order sets, care guidelines and patient education—implemented across all four hospitals by a steering committee
- An effort to build stronger relationship with in-home health services, as well as building relationships with new ones in areas where patients were underserved
- Education of surgeons (hospital-employed and independent physicians with privileges to practice at an Atlantic Health System hospital) on new care standards, and transparent sharing of reimbursement data on a case-by-case basis so surgeons could understand how they were measured compared to their peers.
- The addition of “Navigators”—nurses who communicate with the patients before, during and throughout the 90 days after their procedures, to ensure all clinical resource needs (at-home care, medication questions) are answered quickly. For patients who did end up going to a skilled nursing facility, the navigators were also instrumental in communicating with the skilled nursing facilities to ensure the patient was receiving suitable care and that the length of stay was appropriate.