AMT2 Service Line Development.Task4
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Dec 6, 2023
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AMT2 Service Line Development Task 4 V.2 Steve West
Proposed Service Line Development Demand Demand for an orthopedic service line is evident in the community needs assessment. Trinity Community Hospital (TCH) has an opportunity to meet this demand. The predicted increase in demand for outpatient orthopedic procedures is 350%. Each of these patients will need post-operative rehabilitation as well. With each surgery billing out at $25,000 and another $275 per rehab treatment, TCH stands to see significant increases in annual profits. Over the next five years, there will be a population growth of four percent per year. This means our population over 65 will grow from 13% to close to 20%. The need for orthopedic procedures, particularly total joint replacements, will be in high demand. These patients often need more than one joint replaced, so TCH has an opportunity to impress a population and gain repeat customers. This type of world-class excellence requires state of the art facilities and equipment. International Trends Technologic advancements have significantly improved the accuracy and speed at which surgeries can be performed; however, the availability of new technology varies widely across the globe. For example, computer-assisted orthopedic surgery (CAOS) is dependent on the quality of imaging done prior to the procedure. According to Hafez (2012), a study on CAOS application in Egypt showed that it is particularly effective for complex and neglected cases in developing countries. Since patients in developing areas often do not receive timely or preventative healthcare and surgeons perform less procedures, surgeons and patients benefit from
the accuracy of using computer-guided techniques. With multiple surgeons and potential residents in training, CAOS would be a great opportunity for TCH to maintain proficiency and consistency in our outcomes. In order to meet the demands of CAOS, TCH’s new orthopedic service line will incorporate a state-of-the-art MRI machine. Having a high-resolution imaging system is necessary for effective CAOS, as well as the growing trend of tailored implants specific to each persons’ anatomy. With the right imaging, companies can customize the implants to fit the individual joint using 3-D printing. This leads to shorter procedure times, shorter recovery, and longer longevity for the implant. Another global trend in orthopedic surgeries is toward minimally invasive surgery (MIS). This technique is advantageous as it reduces the risk of complications, pain and recovery times, according to Bharath, 2017. As TCH grows its orthopedic services, the skill of MIS procedures is part of the privileging for some of the new surgeons requesting to perform at our facility. Offering this service to the community sets TCH apart and will decrease infection risks, increase patient satisfaction, and improve operating room revenues. The International Osteoporosis Foundation (IOF) has push
ed initiatives to ‘capture the fracture’ to recognize standards aimed at preventing secon
dary fractures. Based on IOF’s initiatives, Japan is managing post-fracture care of patients via Fracture Liaison Services (FLS). The IOF, (2022), presents data showing that after osteoarthritic hip fractures, patients are four times more likely to have a second fracture and 33% will require nursing care within a year after initial fracture. Japan’s FLS scheme addresses reimbursement for this care as a way of engaging providers to offer preventative treatment to patients after fracture. Part of TCH’s orthopedic
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program will include training for the navigators to guide patients in post-fracture care, follow-up and medication regimens, such that prevention and maintenance is successful. Existing Programs While revenues from the radiology department are typically high, TCH will be able to increase MRI services with the new machine as part of the orthopedic service line. The option to offer a custom joint developed from the images taken onsite is a huge selling point. Another complimentary service is the rehabilitation department. The therapists that work there cover both inpatient and outpatient visits, so patients can continue working with the same therapist after discharge from the hospital. Having Dr. Fred Brian’s provide
r offices adjacent to TCH will lead to provider satisfaction and ease of commute from clinic to operating room. Dr. Joint’s offices will be in very close proximity within the next three months as well. This is a huge improvement from the past, when surgeons covering all three hospitals had to travel across town. To assist in program development and protocols, we will hire an orthopedic navigator who can mimic what the current oncology navigator does. With this hire, the development of education programs will help patients feel prepared for their procedures. This navigator will also help guide appointments, follow-ups, and be a resource for questions about the program. Financial and Operating Data Spending a good portion of TCH’s $25,000,000 capital reserve to fund the orthopedic initiative will pay off. Over the past year, patient volumes have decreased, leading to deterioration of key financial indicators. As the COVID pandemic wanes, patients will come from all over the community for services at our new orthopedic center. The new rehab center on campus will cost $600,000 and the radiology expansion for the additional high-resolution MRI will cost
$3,000,000. This still leaves plenty of capital reserve to put towards projects requiring upgrades over the next 5 years. There is an expected growth and profitability margin of over two million over five years. This department will pay for itself and replenish the capital reserve in a short time. With two of our prominent surgeons moving offices close to our campus, TCH patients will have many options to select from for their preferred surgical experience. The patient satisfaction scores will improve, along with the physician satisfaction scores, thus improving revenue. With an orthopedic nurse navigator providing education, TCH will be able to standardize the process for patients and ensure they are truly prepared for their procedures. This results in a decrease in post-operative complications including infections, falls, and readmissions. Having the orthopedic center onsite will improve efficiencies for surgeons, rehab, post-op visits for patients, and much more. Operationally, an orthopedic center is going to improve the culture at TCH for years to come. Marketing to Physicians If TCH were considering this service line a year ago, it would be almost scary to think who would want to move here and start working for us during a pandemic. However, the messaging from Dr. Joint and Dr. Brian are suggesting this very idea. Both of their groups are opening new office spaces very near our campus. Dr. B
rian’s group has six physicians who have already requested privileges at TCH and Dr. Joint’s group has five more. There is not much need to target physicians to come work with TCH; it will be more of a process to screen the providers currently knocking at the door.
In order to streamline the patient experience, TCH will need to have a collaboration between the surgeons, the radiology department, the operating room, the rehab department and the navigator(s). There is a real opportunity for TCH to evaluate each physician’s protocols and representatives from some top manufacturers of prosthetic joint implants to come give presentations before picking which products we are willing to carry and offer. These efforts will reduce the amount of excess spending on multiple different implants for the eleven different surgeons wanting to practice here. Once we have streamlined processes for the navigators to follow, it will be simple to secure referral services. References 1. Bharath, K. 2017. Top 3 Trends Impacting the Global Orthopedic Surgical Robots Market Trhough 2021: Technavio. Retrieved from: https://www.businesswire.com/news/home/20170413005258/en/Top-3-Trends-Impacting the-
Global-Orthopedic-Surgical-Robots-Market-Through-2021-Technavio 2. Hafez, M.A. 2012. The use of computer-assisted orthopaedic surgery in complex cases of hip and knee arthroplasty; experience from a developing country. From the journal Biomedical Engineering. Retrieved from: https://www.degruyter.com/document/doi/10.1515/bmt-2011-0097/html 3. International Osteoporosis Foundation, 2022. Major milestone for secondary fracture prevention announced in Japan. Retrieved from:
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https://www.osteoporosis.foundation/news/major-milestone-secondary-fracture-
prevention announced-japan-20220607-1345 desired products, so we can ensure there is consistency for the patient. We may even need to get