Guthrie Joint Camp: Improved Care At Lower Cost

Abstract

The Problem: Review of operative procedures within the Guthrie Healthcare System revealed that major joint replacement (DRG 209) was not only decreasing in volume but becoming more expensive. The Goal: To review all aspects of care of patients needing major joint replacement for potenti al opportunities to streamline the experience while increasing quality, decreasing cost, and increasing patient satisfaction. The Solution/Results: To begin the review process, all physician staff, nursing and allied health staff and administration involved in any way in the care of patients needing joint replacement were stimulated to participate in a review of the current practices at Robert Packer Hospital and to compare them to best practices throughout the country. The Musculoskeletal Service Line Leader organized these efforts and initiated the review of DRG 209. As a result of this intense review, practice changes were determined and established using a multidisciplinary approach. It was through everyone's review of their portion of the DRG and a complete restructuring of the DRG 209 process that ‘Joint Camp’ evolved. Its premise is that joint replacement patients are not sick; therefore, a wellness approach was utilized. Initially, physicians eva luated their surgical practice. Through vendor negotiations, supply variances were eliminated and the organization was able to obtain significant cost savings. Next, the patient experience was changed through the use of a ‘coach,’ who helped the patient with rehabilitation during the hospital stay and after discharge. Also, a community setting was utilized for their reh abilitation process. This supportive, yet competitive environment increased their mobility at a faster rate than previously experienced, thus resulting in enhanced outcomes, a decreased length of stay, and a patient satisfaction score in the 99th percentile. Our case numbers have continued to increase, our patient satisfaction scores are continuously in the 99th percentile, the DRG has become profitable, and the quality has been enhanced through the use of the ‘coach.’ This successful Joint Camp program has now been started in Corning Hospital.