Alignment, standardization and sole-source partnership — How Mercy brought the Quadruple Aim to orthopedics

A few years ago, the surgeons and administrative leaders of Mercy's orthopedics department noticed changes in the healthcare landscape and decided to adapt. The Chesterfield, Mo.-based health system, which comprises 40 acute care hospitals and 900 physician practices across four states, had been collecting data but not standardizing implants or processes to deliver the best outcomes and value to their patients.

 This needed to change. During a workshop sponsored by DePuy Synthes at the Becker's ASC Review 26th Annual Meeting: The Business and Operations of ASCs in Chicago on Oct. 24, an expert panel discussed how the health system transitioned to a sole-source partnership with DePuy Synthes and why the arrangement has been beneficial for practicing value-based care. Panelists were:

  • Robert Jones, MD, an orthopedic surgeon with Mercy Hospital Springfield,
  • Jeff Tucker, COO and director of orthopedic services at Mercy
  • Tom Geen, vice president of sales at Raridon & Associates DePuy Synthes – Joint Reconstruction

Bill Wilder, marketing director of U.S. marketing, joints, outpatient for Johnson & Johnson Medical Devices Companies, moderated the panel and opened with a description about aligning sole-source partners to achieve the quadruple aim: achieving quality outcomes, low costs and high patient satisfaction and physician satisfaction. The panelists outlined how the Mercy and DePuy Synthes partnership developed and the benefits it yielded.

Taking a leap of faith

Mr. Tucker and his team realized that in order to remain competitive within their community and prepare for reimbursement changes from both the federal government and third-party payers, the health system needed to deliver the best quality possible and manage costs.

"We spent a lot of time considering and knowing that we needed to go to a sole-source model within our health system for total joints," he said. "The big challenge we faced was how do we even begin to present this to our surgeons … We really had to take a serious look at whether we had the right relationships and whether our surgeons were engaged. Did they trust us? Then we had to take a close look at what we brought to the table as we began discussions with our surgeons because the data had to be right."

The first round of discussions about standardization between the administration and surgeons were not successful. "There was a time we were almost laughed out of the room and we had to keep coming back," Mr. Tucker said. "We had to keep working on that and stay engaged with our surgeons."

On the clinical side, Dr. Jones acknowledged the disconnect that often exists between the administration and surgeons when it comes to patient care; surgeons are absorbed with their practice and do not typically understand the political and financial landscape in healthcare. After a busy day in the operating room, surgeons do not have time to study spreadsheets and truly comprehend how their decisions affect the cost and efficiency of care.

But due to strong communication between the administration and surgeons, Dr. Jones and his colleagues realized they could not stick to business as usual.

"We had to redefine what our goals were and come to a consensus about the realities of the ever-changing healthcare field," he said. "We had to be willing to do our part and be part of the solution with our board in order to become and remain profitable and reach more patient lives."

The Mercy orthopedics team then began discussions on standardizations with vendors, including with Mr. Geen about DePuy Synthes. When DePuy Synthes first began to focus on sole-source partnerships, the company was able to gain competitive footing in the market. The team decided to take a goal-oriented approach to working with healthcare providers to understand their unmet needs and develop a custom solution.

"If we can, we want to provide them with a pathway to walk down together and we'll earn their trust along the way," Mr. Geen said. "This has been a tremendous opportunity. Our partnership has strengthened over time and we're constantly evaluating ways to change the thought about data, analytics, transparency and partnership to just sit at the table together and not pit one versus the other."

Key benefits of sole-source partnerships

Mercy orthopedics transitioned to the sole-source partnership model with DePuy Synthes with a few surgeons as early adopters. When the other surgeons witnessed the clinical, operational and financial benefits of sole-source partnership, they were eager to jump in. The benefits include:

1. Economies of scale: Organizations can leverage a sole source partnership to realize cost savings on individual items as well as rep expertise in the operating room.

2. Efficiencies: With standardized implants, surgeons and their teams can shave five to seven minutes or more off their operating room time because they are familiar with the implants and the operation. "When we began to look at the efficiencies that we were gaining through what DePuy Synthes was bringing to the table for us, we began to see that we were able to give greater efficiency with block time," Mr. Tucker said. "Our surgeons were seeing their block time was becoming more efficient."

3. Tray consolidation: Dr. Jones went from eight trays to two-and-a-half or three depending on the case. This can save time and inventory on the front end, as well as reduces sterilization on the back end. Fewer trays can also lead to faster OR turnover times.

4. Quality of care: As a result of standardization, the team has better data for more precise and reproducible procedures. When patients meet their expectations for post-surgical pain and functionality, they are typically more satisfied with their care. "We now have the ability to truly compare apples to apples, and we are looking at functional outcomes and formalizing functional outcomes for our patients and patient base," Mr. Tucker said.

5. Surgeon satisfaction: The surgeon's No. 1 goal is to achieve great outcomes for their patients and continue to engage in their care. When they are able to deliver those outcomes and perform more cases because their OR becomes more efficient, surgeons have a better experience. "What has affected my life has been the ability to more expertly take care of my patients and the little things that have helped me not only be more efficient, but also a better surgeon," Dr. Jones said. "That often involves leveraging competitive technology."

Preparing for value-based care

In some cases, organizations are wary of sole-source partnerships. Entering into a sole-source agreement is a leap of faith. Health systems and surgery centers do not want to sign a contract and then become trapped by high prices and few options. That was not the experience for Mercy.

"We saw the exact opposite from DePuy Synthes,” Mr. Tucker said. "Instead, the rep's whole focus is on reducing our pain points. Where is the bottle neck? What can be done differently? What hasn't been tried yet? That has revolutionized our group."

And not a moment too soon. Mr. Tucker described the competitive healthcare landscape in his community, which mirrors others across the country. Patients are becoming savvier about their healthcare options and doing more independent research about where to go for their care.

"Patients want to know what the benefits are for coming to Mercy orthopedics versus going to the competitor and now we truly can get solid measures due to the sole source vending we've been able to accomplish," he said. Later, he added, "We want to be able to do this for years to come and we feel that due to this partnership, due to the work that our surgeons have done, that we definitely see a bright light in our future. We're going to continue to be able to do this for many years to come."

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