Geisinger cuts inpatient rehab utilization by half for hip, knee surgery patients

JESSICA KIM COHEN  April 20, 2019 01:00 AM

Two weeks, six weeks and three months. That’s when Dr. Michael Suk, chair of Geisinger’s musculoskeletal institute and orthopedic surgery department, typically sets follow-up appointments for patients after hip or knee surgery.

But a lot can happen in those intervals.

“Those are spot checks in time,” Suk said. “What happens with these patients between the two-week visit and the six-week visit? The six-week visit and the three-month visit?”

To bridge these gaps, Geisinger is now encouraging hip- and knee-surgery patients at eight of its hospitals to speak with their care teams regularly—if not daily—through a web and mobile app. This remote, virtual supervision allows the health system to discharge more patients home after surgery, rather than to post-acute care facilities.

“It’s a program to help keep patients in touch with their providers, in a fashion that goes beyond the emergency phone call.”

Dr. Michael Suk
Chair of Geisinger’s musculoskeletal institute and orthopedic surgery department

Patients nationwide are increasingly being discharged home after total joint surgery, in lieu of skilled-nursing or rehabilitation facilities. That’s in part because of recent trends in reimbursement, such as the Comprehensive Care for Joint Replacement Model, a bundled-payment model Medicare rolled out in 2016.

“Institutions are shortening the length of stay, mobilizing patients earlier and sending them home rather than to a skilled-nursing facility,” said Dr. Donald Goldmann, chief scientific officer emeritus and senior fellow at the Institute for Healthcare Improvement, about changes in orthopedic care. “That’s a national trend.”

Using the app developed by Force Therapeutics, Geisinger patients can access detailed care plans, including videos demonstrating post-operative exercises, and check in with the health system’s nurse navigators. These are the same nurses a patient would engage by phone if they opted out of the program—but patients often feel more comfortable reaching out on the app.

“It’s a program to help keep patients in touch with their providers, in a fashion that goes beyond the emergency phone call,” Suk said. “It allows us to maintain a fairly regular communication stream with our patients.”

Patients can reach out with questions or concerns, such as if they’re experiencing pain or redness around a surgical site. These communications are integrated into Geisinger’s electronic health record, to try to ensure the patient’s entire care team, including nurses and physicians, are up to date on their symptoms and care plan.

Geisinger’s orthopedic team has worked with Force Therapeutics for three years and plans to continue rolling out the technology to all of its hospitals. All patients undergoing a hip or knee surgery at the eight Geisinger hospitals that are live on the technology are eligible to enroll, and more than 95% of them do, according to Suk. To date, roughly 2,000 patients have participated.

Since kicking off the program, Geisinger’s skilled-nursing facility utilization has dropped 20% for hip- and knee-surgery patients, according to internal data from the health system, and its inpatient rehabilitation facility utilization is down 55%, creating some major cost savings.

“We were rapid to discover that a very large portion of total cost of care within an episode of total joint really came from the post-acute world,” he said. Savings from discharging patients home with outpatient physical therapy, rather than to a rehab facility, totals more than $6,000 per patient, according to a 2018 study published in the journal Arthroplasty Today. 

This rise in home discharges seemingly hasn’t had a negative effect on patient outcomes. In fact, the health system’s readmission rate for hip- and knee-surgery patients dropped from 5.5% to 4.5% after implementing the remote program. That’s on par for most hospitals, with readmission rates for total hip replacements estimated at 4% to 11%.

Goldmann said the use of such technologies is part of a larger push to provide more care at home.

“The field is rapidly moving toward home monitoring, telehealth, mHealth,” Goldmann said. “This is a logical next step. Of course, there are many things you have to look at to make sure this is a good next step. … Do everything with an understanding that no technology is going to be suitable for all patients, especially patients with complex needs.”

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