The Overlooked Factor Draining Resources in Orthopedic Care

Billions—to trillions—of dollars are wasted in healthcare spend and although progress has been made toward closing the gap, opportunity remains in often overlooked places. Redundant care is frequently the cost culprit that is being overlooked.

This article originally appeared in MedCity News on August 3, 2022 

Written by Wael Barsoum, MD, President and Chief Transformation Officer at HOPCo

Healthcare has evolved in recent years, becoming more sophisticated and technologically savvy to achieve today’s value-based care goals and deliver on patient-focused promises. Unfortunately, many hospitals are still capped with limited resources making it untenable to fully deliver on the requirements of value-based care.

According to the American Hospital Association, total expenses for our U.S. hospitals are over $1.2 trillion, and that’s not including ambulatory surgery centers, walk-in clinics, physician or specialist practices. The United States has the most expensive healthcare system in the world, but a significant amount of that expense is considered wasteful spending. Recent research suggests wasteful spend in healthcare varies from $600 billion to more than $1.9 trillion per year, or roughly $1,800 to $5,700 per person per year.

There is a heightened sense of urgency to solving the problem of healthcare waste as our aging population and their respective healthcare needs skyrocket. By 2030, 1 in 6 people in the world will be 60 years old or above, and our already overtaxed systems will be forced to take on even more. Particularly for the Medicare population, orthopedic diagnoses and musculoskeletal (MSK) procedures are set to become the leading driver of healthcare spending. As these trends increase, so does the need to find efficiencies and eliminate wasteful spending throughout the orthopedic care continuum.

Cost drivers in orthopedic care

Costly revision surgeries and out-of-network care may be viewed as the obvious culprits when it comes to cost drivers and where we can find efficiencies. However as technology, guidelines and care protocols advance, they are instead the infrequent exception, not the driving factor behind the increased cost of orthopedic care.

Redundant care is frequently the cost culprit that is being overlooked.

MSK care providers are faced with value-based care challenges daily, but eliminating redundant care can immediately drive down costs with zero impact on quality of care, improve the patient experience and even drive positive gains with their MSK care continuum counterparts: the insurance providers and hospitals.

The problem with redundant care

A musculoskeletal patient will likely engage with several providers along their diagnosis and treatment journey, from surgeons and physicians to hospitals and rehab, each with their own respective protocols, electronic medical records (EMR) system, online portals and methods for tracking patient information. That same patient could experience redundant care by being required to get multiple sets of radiographs when only one is needed, because the images aren’t accessible by each provider, in each EMR or online portal. Though redundancies occur in a myriad of different ways, this example depicts how easy it is for miscommunication or lack of coordination to increase cost.

The exact cost associated with redundant care varies greatly as it falls into a variety of wasteful spending categories, each with their own varied descriptions, including:

  • Failures of care coordination
  • Inefficiently delivered services
  • Lack of care coordination

Compounded by the lack of data interoperability, communication and alignment between care providers, the biggest barrier to reducing or eliminating redundancies is the intrinsic sense of mistrust between each group—to the point where they each believe the other doesn’t value what they do or have already done.

Mistrust only grows when you speak or understand language differently—which is often the case with providers, hospital systems and insurance companies. In this case, the language is ICD-10 codes, protocols and guidelines. We can tackle that mistrust barrier and solve the redundant care problem in two key ways: comprehensive, interoperable data exchange, and stakeholder alignment around highly reliable data driven clinical care pathways and an aligned incentive model.

The low-hanging fruit to eliminating waste

Regardless of where you are in the care continuum, it’s known that interoperability is essential to both improving patient care and achieving progress in value-based care initiatives. In fact, a recent report on interoperability by CHIME and KLAS Research shows that, over the next three years, provider organizations are looking forward to robust enhancements to patient-record exchange and population health.

Beyond engaging an EMR vendor, immediate steps that orthopedic care providers and health systems can take toward interoperability is through adoption of health information exchanges (HIEs).  A healthcare network enabled by HIE solutions, standardized care pathways and organized protocols would effectively facilitate a swift exchange of information between the patient’s orthopedic team from the start of treatment through the end of care, helping to decrease the cost of care while improving outcomes.

Building on the foundation and principles of information exchange, a healthcare network can further reduce redundancies through alignment of both the data shared and the stakeholders involved in the orthopedic care continuum. For individual institutions, providers and health systems, information exchange and true stakeholder alignment may seem impossible, but by leveraging a strategic partner skilled in both, it’s an attainable goal.

A strong platform should align all stakeholders, reduce variation and drive standardization of care. Implemented within their growth and cost savings plans, orthopedic healthcare providers leveraging such a partnership should not only improve their operating efficiencies, financial performance and clinical outcomes, but enhance their market share as patients and MSK specialists gravitate to these highly efficient programs.

Redundancies happen, but by leveraging the most advanced analytics and EMR-agnostic decision support tools available, orthopedic care providers can positively impact hospital staff decision-making, reduce redundancies and make headway in driving down costs which ultimately leads to a win for our patients.