Sunday, July 24, 2016

Total Knee Patient Experience Survey for Dr. Tarlow

The quality department at an inpatient surgical facility has provided the following survey summary.

1.  88 % of patients found the preop phone call from the hospital nurse helpful, and none of the patients would have preferred to come to the facility for an in person information session.  In 2016 the need for face to face communication for certain tasks is not desirable.  

2.  3 months after Total Knee Replacement 37 % of patients rated their pain as worse than expected.  The average Total Knee patient needs 9-12 months of healing time so this survey result is expected.

3.  One year after Total Knee Replacement 90 % of people believe the surgery met their expectation and 10 % have not had their expectations met.  This is better than most scientific studies that report 80 % of patients had expectations met.

Friday, July 15, 2016

Insurers Join to Fight Opioid Epidemic

Health Insurers have a large financial role in the delivery of healthcare.  As such, the following actions by Cigna, Blue Cross and Aetna may help decrease opioid addiction.

These insurers will flag customers deemed high risk for abuse.  High risk is defined as patients prescribed large quantities of oxy or hydrocodone or morphine, patients receiving opioid Rx from more than one provider, or long term opioid users.

This is a step in a positive direction.  Society should benefit and accidental death could decrease.

Saturday, July 9, 2016

Low Complication Rate Reported from New Outpatient TJA Facility

Bottom Line
  • The study examined results for 432 patients undergoing TJA at a newly opened outpatient surgery facility over approximately 13 months. 
  • The overall rate of hospital readmission was 1.2 percent.
  • The rate of unplanned access of the healthcare system was 10.9 percent.
  • A statistically significant lower rate of unplanned access to care was seen in the concluding 4.5-month period of the survey versus that in the first 9 months.
This study appeared in the July AAOS Now.  

Our results at SurgCenter of Greater are similar, with no hospital admissions of our series of Outpatient Joint replacements and high patient satisfaction from being able to sleep in their own beds with reasonable pain management.  

Lead author Daniel P. Hoeffel, MD, a surgeon at Summit Orthopaedics in Woodbury, Minn., which opened the ambulatory surgery center in 2014, said that the study represented one of the largest series to date on outpatient total TJA. He said the rates of hospital readmission reported in the study are "lower than those historically reported" for inpatient TJA

The study, presented in a scientific poster at the AAOS Annual Meeting, reported results for 432 patients who underwent either total hip arthroplasty (THA; n = 177) or total knee arthroplasty (TKA; n = 255) in the outpatient surgery center over 13 months. A total of 12 adverse events occurred, with five patients (1.2 percent) requiring hospital readmission. Two of these were due to swelling with pain or hematoma, and three were for dislocation, pneumonia, or infection.

Friday, June 24, 2016

Insurance Prior Authorization - Hope for Common Sense Changes

The Ohio Legislature is the considering a proposal that makes so much sense it is hard to believe the issue is just now being addressed.  Here to the hope that other states will act quickly and take similar action.

Nothing is more frustrating to patients and physicians than the prior authorization process that requires physician offices to ask permission via telephone from the insurance carrier to treat the patient.

This system is cumbersome, multilayered and lengthy.  This process interferes with the sacred doctor-patient relationship.  Most egregious is the insurers ability to retroactively negate a written approval for care after a patient has received treatment.

Ohio SB 129 has passed the Senate and will be addressed in the State House.  

SB 129 will make the following changes to the prior authorization system in Ohio:
  • create a uniform web-based system for submitting prior authorization requests 
  • establish timeframes within which a prior authorization request must be responded to 
  • ensure that once a prior authorization has been secured, an insurer is not able to retroactively deny coverage for that authorization
  • ensure that all new or future prior authorization requirements are disclosed to the provider community at least 30 days in advance
  • guarantee turnaround on prior authorization requests and quicker turnaround for more urgent requests 
  • mandate that prior authorization protocols use evidence-based clinical review criteria 
  • create a streamlined appeals process in the case a prior authorization is denied
The medical community in Ohio, working with its partners and creating a diverse coalition, has successfully moved legislation to reform the practice of prior authorization.

Friday, June 17, 2016

80 % Chance Your Orthopedic Surgeon Will Not Be There in 2 Years

Hospital corporations and physician groups are merging to create mega corporations in response to the ACA.  Hospital corporations and large group practices are hiring Orthopedic Surgeons as corporate employees.  There are fewer private practice small group Orthopedic Surgeons in our country. Young physicians do not feel confident enough to get a loan and join/start a small practice.


After 10 years of training including medical school, residency and fellowship one would think young surgeons would be ready to find their dream job and settle in for a long and productive career.

An unintended consequence is dissatisfaction with the hospital or large group employment model.  These young physicians are 80 % likely to change jobs within their first 2 years of practice.