As healthcare reform continues to change the provision and payment of care, orthopedic surgeons and providers of musculoskeletal (MSK) care are challenged to find ways to redesign the coordination and delivery of their services. Healthcare systems, meanwhile, are struggling to develop strategies to keep up with increasing competition from other health systems and physician-owned facilities, including ambulatory surgery centers (ASCs), advanced imaging, physical therapy, and urgent care centers. So how are organizations positioning the MSK service line to thrive in this changing landscape? Let’s explore the five components of the value-based enterprise – integrated, scaled, rationalized, informed, and responsive – and apply them to the delivery of MSK services.
MSK services must span the complete continuum of care – from operative and nonoperative services designed around preventive medicine to acute and post-acute care. This requires a thoughtful, multidisciplinary approach to care pathways and protocols that are based on clinical conditions such as osteoporosis, back pain, and elderly fractures, and supported by measurable outcomes.
Prevailing MSK service lines and private physician practices align with strategic partners to secure needed services and enhance market coverage; strategically and efficiently deploy capital for resources; cultivate population health competencies; and achieve economies of scale. Health systems that have built a strong, successful primary care network that fosters a culture of patient retention will be better able to scale their MSK services to ensure patients are treated within the system, thus ensuring continuity of care.
Along with reducing costs and enhancing efficiencies, leadership of MSK services across a system of care increasingly must consider consolidating or redistributing key programs (e.g., joint replacement) to optimize resources and ensure the provision of high-quality care in the most accessible manner. Consolidation may not be the right solution for larger, multihospital systems, but leadership should evaluate the delivery system at each hospital to understand variations in quality, outcomes, and cost, with the goal of creating a consistent patient experience across the entire MSK enterprise.
MSK leadership should be well informed about potentially drastic shifts in the payment environment at the local, regional, and national levels. Further, they need to effectively leverage operational and clinical data to inform the strategic and operational decision-making process relative to their MSK service line. Organizations that have their finger on the pulse of private orthopedic practices work to engage orthopedic surgeons in the strategic direction of the service line to dissuade them from pursuing independent strategies (e.g., opening an ASC).
High-performing MSK programs will exhibit lean, well-defined, and proactive decision-making structures that decisively drive the organization forward, particularly during times of change and uncertainty. They will engage their orthopedic surgeons and other MSK providers in the governance of the service line and demonstrate action by executing key strategies.
Does your organization’s MSK service line exhibit the characteristics of a value-based enterprise? If not, it’s time to get your orthopedic surgeons involved and evaluate the fundamental attributes of your services to ensure the foundation is established for successful execution of key strategies and ideas.