A Novel, Synergistic Model in Total Joint Arthroplasty: A Report of 2 Specialty Hospitals With Joint Ownership Between Physicians and Healthcare Systems.

BACKGROUND: In 2010, the Affordable Care Act introduced new restrictions on the expansion of physician-owned hospitals (POHs) due to concerns over financial incentives and increased costs. The purpose of this study is to determine whether joint ventures between tertiary care and specialty hospitals (SHs) allowing physician ownership (POHs) have improved outcomes and lower cost following THA and TKA. METHODS: After institutional review board approval, a retrospective review of consecutive series of primary THA and TKA patients from 2015 to 2016 across a single institution comprised of 14 full-service hospitals and 2 SHs owned as a joint venture between physicians and their health system partners. Ninety-day episode-of-care claims cost data from Medicare and a single private insurer were reviewed with the collection of the same demographic data, medical comorbidities, and readmission rates for both the SHs and non-SHs. A multivariate regression analysis was performed to determine the independent effect of the SHs on episode-of-care costs. RESULTS: Of the 6537 patients in the study, 1936 patients underwent a total joint arthroplasty at an SH (29.6%). Patients undergoing a procedure at an SH had shorter lengths of stay (1.29 days vs 2.23 days for Medicare, 1.15 vs 1.86 for private payer, both P < .001), were less likely to be readmitted (4% vs 7% for Medicare, P = .001), and had lower mean 90-day episode-of-care costs ($16,661 vs $20,579 for Medicare, $26,166 vs $35,222 for private payers, both P < .001). When controlling for the medical comorbidities and demographic variables, undergoing THA or TKA at an SH was associated with a decrease in overall episode costs ($3266 for Medicare, $13,132 for private payer, both P < .001). CONCLUSION: Even after adjusting for a healthier patient population, the joint venture partnership with health systems and physician-owned SHs demonstrated lower 90-day episode-of-care costs than non-SHs following THA and TKA. Policymakers and practices should consider these data when considering the current care pathways.

Practical Guide to Delivering Surgical Skills Courses in a Low-Income Country: Knowledge Gained From a Surgical Education Partnership in Haiti.

Routine surgical skills training is known to advance a surgeon's technical proficiency. However, orthopaedic providers in low-income countries have limited access to skills training programs. International academic partnerships can augment locally available orthopaedic education, improving the quality of and capacity to deliver orthopaedic care in low-income countries. The objective of this study is to provide a practical guide to delivering an orthopaedic skills training course in a low-resource setting. The information provided is based on the experiences of the authors, along with specific feedback from previous course participants in Haiti.

Study of the evolution and variability of nontraumatic orthopedic surgeries in Brazil-9 years of follow-up: A database study.

In Brazil, there are no epidemiological statistics that map nontraumatic orthopedic injuries, their rate of variability, distribution by specialty, fatality rate, and the economic impact that these lesions and their consequences can bring to the country. The objective of this study was to evaluate the rates of variability for skills, deaths, mortality, and the economic impact of nontraumatic orthopedic surgeries in Brazil from 2008 to 2016.This is a descriptive study conducted through the analysis of data relating to the indicators of hospital production regarding orthopedic procedures of the Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de saúde-DATASUS) between 2008 and 2016. The level of significance was 5%.There was a predominance of hospitalizations for surgery of the lower limbs, which also resulted in the largest number of deaths. The surgical mortality rate recorded for the hip also needs to be considered. In general, there is a national increase in the number of orthopedic surgeries performed, accompanied by a concomitant increase in the number of deaths and mortality of the population exposed.We observed a growing demand for hospitalization with a consequent increase in lethality and deaths. We can conclude that between 2008 and 2016, the number of hospitalizations for elective nontraumatic orthopedic surgical procedures increased significantly, driven mainly by lower limb surgeries, along with the cost of the Unified Health System (Sistema Único de Saúde-SUS) for these surgeries.

Is There Value in Having Radiology Provide a Second Reading in Pediatric Orthopaedic Clinic?

BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations specifically mandates the dual interpretation of musculoskeletal radiographs by a radiologist in addition to the orthopaedist in all hospital-based orthopaedic clinics. Previous studies have questioned the utility of this practice. The purpose of this study was to further investigate the clinical significance of having the radiologist provide a second interpretation in a hospital-based pediatric orthopaedic clinic. METHODS: A retrospective review was performed of all patients who had plain radiographs obtained in the pediatric orthopaedic clinic at an academic children's hospital over a 4-month period. For each radiographic series, the orthopaedist's note and the radiology interpretation were reviewed and a determination was made of whether the radiology read provided new clinically useful information and/or a new diagnosis, whether it recommended further imaging, or if it missed a diagnosis that was reflected in the orthopaedist's note. The hospital charges associated with the radiology read for each study were also quantified. RESULTS: The charts of 1570 consecutive clinic patients who were seen in the pediatric orthopaedic clinic from January to April, 2012 were reviewed. There were 2509 radiographic studies performed, of which 2264 had both a documented orthopaedist's note and radiologist's read. The radiologist's interpretation added new, clinically important information in 1.0% (23/2264) of these studies. In 1.7% (38/2264) of the studies, it was determined that the radiologist missed the diagnosis or clinically important information that could affect treatment. The total amount of the professional fees charged for the radiologists' interpretations was $87,362. On average, the hospital charges for each occurrence in which the radiologist's read provided an additional diagnosis or clinically important information beyond the orthopaedist's note were $3798. CONCLUSIONS: The results of this study suggest that eliminating the requirement to have the radiologist interpret radiographs in the pediatric orthopaedic clinic would have few clinical consequences. LEVEL OF EVIDENCE: Level III-This is a diagnostic retrospective cohort study.

PPD-QALY-an index for cost-effectiveness in orthopedics: providing essential information to both physicians and health care policy makers for appropriate allocation of medical resources.

Because of the increasing health care costs and the need for proper allocation of resources, it is important to ensure the best use of health benefits for sick and injured people of the population. An index or indicator is needed to help us quantify what is being spent so that comparisons with other options can be implemented. Cost-effective analysis seems to be well suited to provide this essential information to health care policy makers and those charged with distributing disability funds so that the proper allocation of resources can be achieved. There is currently no such index to show whether the benefits paid out are the most cost-effective. By comparing the quality-adjusted life year (QALY) of a treatment method to the disability an individual would experience, on the basis of lost wages as measure of disability, we provide decision makers more information for the basis of cost allocation in health care. To accomplish this, we describe a new term, the PPD-QALY (permanent partial disability-quality of life year). This term was developed to establish an index to which musculoskeletal care can be compared, to evaluate the cost-effectiveness of a treatment on the basis of the monetary value of the disability. This term serves to standardize the monetary value of an injury. Cost-effective analysis in arthroscopic surgery may prove to be a valuable asset in this role and to provide decision makers the information needed to determine the societal benefit from new arthroscopic procedures as they are developed and implemented.

Latin American foot and ankle surgery today.

Latin American medical orthopedic sub specialties have evolved a lot during the past decade. Foot and ankle surgery for instance, has gained high level of proficiency and competence throughout the international scientific communities. This may be due to the availability of new technology in osteosyntheses, orthopedic devices and surgical instruments used to optimize results, regardless of the low economic resources Latin American countries possess. Also, foot and ankle surgery training is being promoted by several International Medical associations that pursuit scientific knowledge and strengthen the practice. Day to day, more Latin American universities offer Fellowships for on-going training.

Managing orthopedics and neurosciences costs through standard treatment protocols.

High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines can provide substantial revenue as well as the opportunity to achieve a "center of excellence" competitive position in a managed care environment. This Special Report outlines the process and advantages of managing costs and quality of care strategically, that is, in a manner which helps these programs meet internal cost and clinical goals while responding to market situations. The hospital, physicians, and patients all benefit as costs are reduced, quality is enhanced, and the service line's competitive position is strengthened.

Porgrama de cirugía extramuros: campaña de las deformaciones óseas de los pies 1991 / Program of extern surgery. Campaign of bone deformities in feet 1991

El documento proporciona información presupuestaria, para el año de 1991, sobre el "gasto consolidado anual", "gasto realizado de enero a junio" y "presupuesto de gasto de julio a diciembre" en la operación del "programa cirugía extramuros" el cual está integrado por "campañas de las deformaciones óseas de los pies"; tal información se presenta desagregada en los capítulos de gasto (materiales y suministros, servicios generales y bienes muebles e inmuebles), dichos gastos son concernientes a las "campañas realizadas y/o por realizar en los Estados de Chiapas, Michoacán y Oaxaca, México. Asimismo, el documento indica el monto del presupuesto que se ha erogado o por erogar para las campañas: tercera, cuarta y quinta en Chiapas; segunda y tercera en Michoacán y, primera y segunda en Oaxaca

Informe de labores del director 1990 / Labor report of the director 1990

Las actividades realizadas por el Instituto Nacional de Ortopedia (INO), México, durante el año de 1990, comprenden los siguientes conceptos, de algunos de los cuales se proporcionan datos: 1.-Investigación. De 26 investigaciones programadas 16 están en proceso, 3 en evaluación, 2 en espera de publicación, 1 publicada y 2 suspendidos. 2.-Enseñanza. Se realizó el "taller de osteosíntesis"; cursos de especialización en ortopedia y traumatología; se otorgaron 60 "campos clínicos" a médicos residentes (medicina de rehabilitación, anestesiología, psiquiatría y ortopedia y traumatología); se efectuaron 116 sesiones para diferentes tópicos y se efectuaron diversos "cursos monagráficos", se realizó el "congreso nacional de ortopedia", asimismo se efectuaron diversos cursos y actividades específicas de enseñanza para enfermeras y demás personal paramédico. 3.-Atención médica. Se proporcionaron 44 mil consultas externas y se atendieron de urgencia a 10,650 pacientes; se hospitalizaron 2,942 personas; se realizaron 250 mil sesiones de terapia de rehabilitación; en servicios auxiliares de diagnóstico se efectuaron 28,730 estudios (entre ambulatorios, hospitalarios y de urgencias), 79,770 de laboratorio, 284 de patología, 90 de tomografía axial, 30 de ultrasonido y, se captaron 1,553 unidades de sangre. 4.-Morbilidad y Mortalidad en el INO, se proporcionan algunos datos de las causas prevalecientes registradas en este concepto. 5.-Referencia y contrarreferencia, 1,536 pacientes en este concepto. 6.-Campaña de detección de deformidades en las extremidades inferiores, se llevo a cabo en Distrito Federal y en los Estados de Tlaxcala e Hidalgo, México, con un total de 5,133 niños examinados. 7.-Cirugía extramuros (campaña), se llevó a cabo en los Estados de Guerrero, Chiapas y Michoacán, México, proporcionándose 728 consultas. 8.-Informe financiero, se proporciona el monto del presupuesto ejercido y los movimientos de gasto y financieros realizados. Este mismo documento contiene el "Programa 1991" del INO, principalmente de metas