G. Daxton Steele, M.D. Meets With Congressional Representatives to Evaluate Comprehensive Care for Joint Replacement
G. Daxton Steele, M.D., an orthopaedic surgeon and hip and knee replacement specialist at Andrews Institute for Orthopaedics & Sports Medicine, recently traveled to Washington D.C. with a group of representatives from the American Association of Hip and Knee Surgeons (AAHKS) to speak with congressional representatives about improving patient access through the Comprehensive Care for Joint Replacement (CJR) model. The CJR payment model, which was initiated on April 1, 2016, is a pilot program through the Center for Medicare Services (CMS) that incentivizes hospitals and physicians to manage the cost of care for inpatient hip and knee replacement surgeries.
While the program has been very successful in the short time it has been in place, Dr. Steele and representatives from AAHKS believe there is room for improvement.
“Our main agenda for this trip was to start a dialogue about improving patient access for hip and knee replacement surgeries,” Dr. Steele said. “Overall, (CJR) has been positive; we definitely think it has improved patient care. The program has really helped to reduce the cost of total joint surgeries and helped reduce unnecessary expenses. However, it has created a slight vacuum, in that it has also incentivized physicians to select patients that are less likely to have problems or less likely to have complications.”
While the subsets of patients with modifiable problems like obesity, smoking or uncontrolled diabetes can become candidates for hip and knee replacement surgeries after the problems have been addressed, there is still a group of patients with problems that are not fixable who are not receiving the same access to care through CJR.
“These patients with high risk factors are candidates for surgery, but studies have shown that their chance of having a problem is slightly higher than the rest of the population,” Dr. Steele said. “So what’s happened is that hospitals are starting to prevent or incentivize physicians not to do those. And those patients are getting sort of left out in the cold.”
One of the subsets of patients with high risk factors includes organ transplant patients.
“Patients that have a heart or lung transplant are on medications that are notorious for causing hip and knee arthritis,” Dr. Steele said. “They have a much higher risk than the average patient for getting an infection because of their transplant medications. The patient and I have to make a decision on best options. While we can move forward with the joint replacement surgery, there is a higher risk for complications. Most surgeons and hospitals are not taking that risk and a lot of those patients are not receiving access to the same level of care across the country.”
Escambia and Santa Rosa counties are one of 67 geographic areas where CMS has implemented the CJR model. Andrews Institute is actively adapting its total joint program to provide access to its patient population while working within the program confines to reduce costs and meet quality indicators defined by CJR.
“We are actively involved in the CJR model at Andrews Institute,” said Beau Pollard, executive director of the orthopedic service line at Andrews Institute. “We have a team focused on this initiative that includes nurses, administrators, physical therapist, case managers, physician assistants and physicians so that we are successful in providing quality care from optimizing the patient prior to surgery, their hospital stay and throughout their road to recovery.”
Hip and knee replacement surgeries are both the most common inpatient surgery and the number one expenditure for Medicare.
“Getting this right is important,” Dr. Steele said. “Trying to reduce costs is the overall aim of this whole program. We don’t have an exact solution but we are starting the dialogue. As physicians, we are trying to look at this program from a clinical perspective. Since this program has been implemented, it has been very positive from a financial perspective. However, we want to better understand how we can create better access for all patients that are candidates for hip and knee replacements.”
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