The Surgical Center at Columbia Orthopaedic Group in Missouri, like so many ambulatory surgery centers across the country, does procedures today that are far more complex than those it did five years ago.
“In the past, we haven’t worried as much about coordinating care across the patient journey, from preoperative education to surgical aftercare,” said Andrew Lovewell, administrator. “But as the sheer complexity of our procedures increased, we wanted our patients to have remote access to instructional videos and better connectivity with their care teams.
“We didn’t want to complete surgeries in a transactional way, without any intimacy or continued communication with the patient to ensure they were experiencing excellent results,” he added.
As one of the top surgery centers in the nation per Newsweek for both 2021 and 2022, The Surgical Center at Columbia Orthopaedic Group felt it was representative of its quality and reputation to create a system that improved the care it offered patients.
“During the early stages of the pandemic, we had many patients that were afraid of going to physical therapy, and several facilities were shut down for extended periods,” Lovewell recalled. “We knew we needed to create an environment of safety while still retaining control over our patients’ recovery journey.
“We wanted to gain insights into how patients were recovering at home, see feedback on their progress and outcomes, and enrich the patient experience from start to finish,” he said.
To help meet this goal, the ambulatory surgery center contracted with health IT vendor Force Therapeutics, which offers a digital care management platform that leverages clinical data and custom protocols to educate patients and monitor their progress throughout an episode of care.
“The platform uses clinical care paths, adaptive education, personalized goal setting and virtual physical therapy to drive a smooth and efficient recuperation,” Lovewell explained. “The platform also captures patient input and makes real-time adjustments to care paths as necessary, such as changing the type of exercise video presented based on patient feedback regarding the difficulty level of the last video.
“The platform was designed to supplement our standard pain-scale reporting with questions about recent levels of activity, or how well the patient is following their medication regimen,” he continued. “Depending on the answers, a patient might then be advised on how to rest following activity, or how to alternate anti-inflammatory medications for better pain relief.”
The platform alerts the patient’s care team when needed, prompting clinicians to check in with the patient about mobility issues, pain management or other concerns.
“Despite a common misconception that remote care management platforms replace direct care from providers, the platform is intended to complement the treatment course and reflect providers’ messaging,” Lovewell said. “It helps to strengthen the patient/physician relationship, as all content and care protocols are prescribed and shaped by the patient’s physicians.
“Instead of randomly searching online for medical information about their surgery, patients can trust the Force platform, as they know this information is clinically validated and approved by their surgeon,” he continued. “Patients also can message their care teams through the platform to confirm information or clarify a postoperative symptom they’re experiencing.”
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MEETING THE CHALLENGE
About two years ago, The Surgical Center at Columbia Orthopaedic Group launched the Force Therapeutics care management platform to connect patients to their care teams throughout their recovery process. Today, 22 of 27 of the center’s surgeons are on the platform, including all sports medicine, spine and total joint surgeons.
“As soon as the patient is scheduled for surgery, they receive a notification via text or email to sign up for the platform, which is integrated with our homegrown scheduling system,” Lovewell said. “Before their surgery, patients log into the platform to learn how they can prepare themselves and their homes for a good recovery.
“The platform helps patients really remember and internalize instructions because it offers short, digestible videos at the best time in the process, which is right before the patient needs to know that particular piece of information,” he continued.
The platform also is integrated with the center’s documentation software, Emme, which it uses in the postoperative stay suite at its lodge.
“After patients are discharged, they typically become a guest at our lodge for one night before they return home,” Lovewell explained. “Demographic data is imported from Emme into the Force platform to inform care path personalization.
“Once they’re home, patients log into the platform throughout their recovery to complete their physical therapy videos and get individualized tips for dealing with mobility issues and any pain they might have,” he added.
“Now, our surgeons will respond to all their patient messages while they’re on call, as opposed to the patients needing to come to the ER or urgent care to be seen by an entirely different care team.”
Andrew Lovewell, The Surgical Center at Columbia Orthopaedic Group
Force Therapeutics developed all of the content the center uses in the patient care paths, but the center spent time refining its own custom protocols so it could track the data it wanted and get the specific alerts it needed to improve outcomes.
“We started with just five total joint surgeons on the platform, which helped us figure out the cadence of how the videos should be rolled out to patients,” Lovewell said. “We incorporated patient feedback to adjust and tweak our protocols, and then we arrived at a product that is delivering really great results.
“Our surgeons use the platform’s data on a daily basis,” he added. “We produce monthly internal reports that compare each surgeon’s key performance indicators to their colleagues’ KPIs, and Force data is included in that report. For example, surgeons might notice their care team takes longer to respond to patient messages than their partner’s care team does. Can they change their habits to address that lag time?”
Most important, according to Lovewell, the platform has given the center a way to assess quantitative results in terms of patient outcomes. Rather than just relying on their expertise to evaluate patient outcomes at a postoperative visit, surgeons can track how their patients are doing on several scales and compare that progress to that of other patients.
“This also leads to protocol improvements because as we analyze the data, trends become clear: This particular patient cohort does better with outpatient physical therapy rather than outpatient home health, while this medication prevents more postoperative swelling than alternative medications, especially when given at a specific interval,” he explained. “We’ve developed a great cycle of continuous improvement because of the data analytics this tool enables.”
In the areas of productivity and volume, The Surgical Center at Columbia Orthopaedic Group has increased productivity because it’s getting more patients to flow through the clinic more efficiently.
“When we started with Force, we were probably doing about 60 total joint procedures a month, and 20 spine cases,” Lovewell recalled. “Now we’re up to 120 joint procedures a month and 40 spine cases. Of course, this can’t be attributed entirely to digital care management, but it’s a big component.
“Previously, our doctors saw patients in the clinic for their preoperative education visit and explained what the procedure does and what the recovery process would be,” he continued. “We also had hired a nurse navigator to gather the patient’s pre-operative information and make patient calls ahead of time.”
Now, with the platform, the center can scale business much faster because it has reduced so many manual intervention points.
“Instead of our doctors spending hours upon hours in the clinic doing patient counseling, we are much more strategic with their time,” he reported. “Our doctors are talking to patients about much more meaningful topics, not simply repeating the same preoperative speech over again. We’ve hired more nurse navigators to enable the greater volume.
“The platform takes on the brunt of the work for care coordination, and we fill in the gaps,” he continued. “If a patient isn’t engaging with the platform or watching their physical therapy videos, we step in to help. As we’re addressing such a big percentage of patient concerns through the combo of the Force platform and our nurse navigation program, our doctor offices are not getting bogged down in the back-and-forth of phone tag just to answer a simple patient question.”
Then there are lower readmission and infection rates. As an ambulatory surgery center, it has to be very intentional about collecting readmission data from the regional hospital. It asks its doctors to self-report on infection-control tracking and readmission tracking, and all patients fill out a survey about 30 days after surgery, which asks about their recovery.
“The Force platform helps us serve as a first line of defense when questions arise, so we can divert patients away from urgent care or the ER,” he said. “We know from past experience that most of our patients’ postoperative concerns are superficial issues – their wound looks red, or there is drainage from the incision site.
“If a patient messages us through the platform with a concern, we answer the question, point them to the right digital education resource and follow up with them to ensure they don’t have any further concerns,” he added.
Prior to using the platform, the center’s infection rate for total joint surgeries was already quite low – four infections out of 800 surgeries. Since it implemented the platform, that rate has dropped to one infection out of 1,800 surgeries.
“There’s been a very stark difference although it’s hard to say with utter certainty the primary cause,” Lovewell noted.
On another front, there is patient-reported outcomes data. As a high-touch ambulatory surgery center, it already had very high patient satisfaction scores before it implemented the platform because it concentrated on making the patient experience as seamless as possible, Lovewell said.
“But we have found that patients love the added sense of connection that the Force platform brings, and we hear these comments in our surveys,” he noted. “They love being able to message their doctors, and they really appreciate saving money on their copays and not needing to go to so many outpatient therapy appointments.
“This enthusiasm for the platform is reflected in our patient-reported outcomes data and collection rates,” he continued. “When I first saw these quarterly reports, I didn’t believe the numbers could be right, but it’s true: 96% of our patients take the time to complete a one-year postoperative outcome assessment via the platform. That compliance rate is just off the charts.”
Having those granular insights and outcome assessments from 96% of patients lets the center understand quantitatively how it is doing.
“It gives our physicians reassurance and real-time feedback to make changes to their protocols, if necessary,” Lovewell said. “Collecting the data also is very important to us from an accreditation standpoint and gives us a way to benchmark ourselves with similar groups. Without this key insight, we would be flying blind and assuming that we are already operating at our highest ability.”
ADVICE FOR OTHERS
When The Surgical Center at Columbia Orthopaedic Group first launched the digital care management platform, several doctors were hesitant, especially about the patient messaging functionality. They felt that patients already had the access they needed, and they didn’t want a barrage of messages.
“And now, the messaging function is one of the features that our surgeons like the best,” Lovewell reported. “They can message patients directly, and if a patient’s message is escalated to them, they can log in and investigate the patient’s outcomes before responding.
“We’ve created a direct conduit for our providers to get instant feedback on how the patients are doing via a quantitative method, not just a qualitative one,” he said. “Now, our surgeons will respond to all their patient messages while they’re on call, as opposed to the patients needing to come to the ER or urgent care to be seen by an entirely different care team.”
When a patient can access their care team virtually rather than in person, that’s a tremendous time and cost savings for everyone involved – the patient, the provider, the payer and the country’s overall health spend, he added.
“In reality, the best advice I would offer to other healthcare providers considering using a similar technology is to thoroughly assess the technology to make sure it fits your unique needs,” Lovewell said. “Not every practice is the same, and not every solution is the same.
“There are several platforms that just track outcomes, or just have messaging components built in,” he concluded. “We wanted a full-scale solution that gave us everything in one platform. Being able to message patients, track their progress, and offer a virtual care solution that saves patients time and money is a huge value-add for the patients we serve.”