By Sal Casillas
How one multi-specialty surgery center is making big investments and taking big risks to grow with outcomes-based payment models
Benita Tapia at 90210 Medical Center, a high-performance multi-specialty surgery center in Los Angeles, knows all about the pressures medical group practices are undergoing to deliver quality outcomes to patients in a changing healthcare environment. Since 2006, Tapia has been the administrator for 90210 Medical Center, and last year, she led the clinic in pioneering same-day discharge for total joint replacement surgery. 90210 Medical Center is an example of practice growth that blends health technology tools with innovative surgical techniques and the recruitment of top physician talent. Its investment in these key areas has helped the surgical practice create patient demand, operations growth and successful navigation of new value-based care models.
“For healthcare organizations across specialties, it’s time to focus more aggressively on the shift from volume to value-based care. The train has already left the station.”
90210 Medical Center is setting a precedent for delivering innovation for the highest quality care to patients under tight operating margins. In our conversation, Tapia outlined how high-performance medical practice groups can explore ways to transform the traditional fee-for-service system and prepare their organizations to find innovative ways for patients to engage with surgeons and their care teams.
A Paradigm Shift For Care Management and Incentive Payment
The Centers for Medicare and Medicaid Services (CMS) launched its first-ever mandatory outcomes-based payment program in April 2016. When CMS focused on joint replacement procedures first, orthopedic surgery moved to the front lines of healthcare’s payment reform. 90210 Medical Center was not only prepared for this shift to outcomes-based models, but the practice is also working to get their innovative clinical approach recognized as the standard of care across the country.
Quickly disappearing are the days when a patient’s surgical procedure starts in the operating room. By the time someone arrives for surgery at 90210 Medical Center, Tapia explained that their patient knows exactly what to expect, their home situation has been evaluated, a physical therapy plan has been completed and medications have been set up. These are only a handful of the preparations the clinic has set up to provide a successful same-day discharge for total joint replacement surgery. 90210 Medical Center has developed a collaborative system that ensures the success of each surgery by providing high levels of transparency across the surgeon, care team, and patient.
“At 90210 Medical Center, we realize surprises are costly. Surprises are unexpected complications in the patient’s recovery. An infection after the surgery translates to additional care and resources for the patient’s safe recovery. Because our practice receives a set amount under the value-based system, the complications are ultimately paid by the practice. Being at the forefront of patient education is fundamentally crucial for us to avoid any patients experiencing a treatment failure.” When patients see a true continuity of care with the same care team throughout the process, they return home more comfortable and happier.
To avoid surprises while also innovating total joint replacement surgery, the clinic assembled an extraordinary team early on. “Our same-day total joint replacement program was led by a surgeon from a nearby hospital who was already creating outstanding outcomes. The surgeon is our team leader, and the team is comprised of an administrator, anesthetist, director of nursing, physician’s assistant, physical therapist and a patient-physician coordinator,” said Tapia.
90210 Medical Center is able to measure clinical quality and outcomes for procedures by implementing technology to capture patient satisfaction and control cost. “We rely on technology to provide a method for measuring quality and obtain consistent data on any problems that may emerge.” With this data collected, the medical practice benchmarks and tracks outcomes. The data is compared to patient satisfaction surveys and national and local benchmarks for quality and safety, and the results tell us whether we are reaching our goals.”
The clinic is using their detailed reporting to demonstrate success as a new standard of care for joint replacement surgery since CMS does not currently approve total joint replacement procedures in an ambulatory surgical center (ASC) setting. 90210 Medical Center is planning to work with The Joint Commission to develop a specialization certification for ASCs performing total joint replacements.
A medical group administrator can’t innovate and adapt alone. Tapia recommends medical groups begin by putting a team together as the very first step. Use the talents of these clinicians and staff to find the right technologies for patient care both inside and outside the practice setting. Complete the cycle by tracking every innovation with detailed measurements to ensure that you’re reaching the best possible patient outcomes. When medical groups focus on innovation together as a team, not just reacting to regulatory change but staying ahead of it, they can take the lead in their communities to thrive as a practice while delivering outstanding patient care.
