When Baltimore's Mercy Medical Center named Marc W. Hungerford, MD, chief of the division of orthopedics, his mission was clear and no less daunting: Upgrade Mercy's total joints program so it could compete with those at nearby behemoths University of Maryland and Johns Hopkins. Sure, Dr. Hungerford had run successful total joints programs at previous institutions, but this time he brought in a powerful and prestigious partner — a consulting service created by a top orthopedic instrument and implant maker.

Now in its 8th year, the partnership has worked wonders. The results speak for themselves. Mercy's key total joints indicators have decreased significantly: costs by 20%, blood transfusion rate by 75%, lengths of stay by 35% and discharges to nursing homes by 80%.

Would it have been difficult for Dr. Hungerford to dig deep into outcomes data and make those changes on his own? "No," he says. "It would have been impossible.

"We've improved the quality of care we deliver, decreased our costs and increased our case volume and profitability," he continues. "We're able to assess what's actually going on in the big picture instead of trying to chase small problems one at a time. The partnership has been really effective for us." Orthopedic implant and instrument makers are getting into the consulting business because, let's be honest, a facility that relies on their advice is also more likely to use their products. But the company's consulting services are separate entities that can be incredibly useful resources if you're looking to launch a same-day joints program or breathe new life into your existing one.

1. Save time and sweat

Building a total joints program from scratch is a daunting task made easier when consultants provide proven patient care pathways that you can reference and adapt as needed to fit your facility's specific needs. Consulting companies also help you identify equipment needs, what staffing levels are required and how staff should be trained.

"Most surgeons and administrators don't have experience with building the many elements needed to run a successful joints program, and one way they can learn about what it takes to implement a program is to spend significant time and money visiting other facilities," says C. Lowry Barnes, MD, of the department of orthopedics at University of Arkansas for Medical Sciences ?in Little Rock. "But that's time consuming and costly."

You don't have to spend the time, money and sweat equity to do it on your own, says Diane Doucette, MBA, RN, president of the Mount Carmel New Albany (Ohio) Surgical Hospital. "Why reinvent the wheel if you can get access to proven safety and quality outcomes?"

2. Facility-specific advice

Let's say your current post-op length of stay is 3 days. What will it take to achieve 23-hour stays and, ultimately, to discharge patients 5 hours after surgery? Consulting companies will map out the plan to make it happen and help you achieve regular milestones until patients are heading home soon after surgery.

"The advice and insights you receive are based on your unique situation and current continuum of care," says Ms. Doucette. "That's the beauty of these programs — every type of facility can glean something from the relationship, regardless of where they are in relation to the ultimate goal of same-day discharging."

3. Improved patient communication

Consulting companies can inform patients about exactly what to expect on the day of surgery and how to best recover at home after procedures are performed, points out Dr. Barnes. "Patients perceive the company's reps as representing us because in fact they do," he says. "They're in our meetings, they have clinical backgrounds and they fully understand our processes."

A company's representatives can call patients before scheduled procedures to answer questions they might have about the entire episode of care, confirm their attendance at mandatory pre-op patient education classes and identify modifiable risk factors. They can work with smokers to help them kick the habit, diabetics to lower blood glucose levels and narcotic users to have them stop taking the medications. They set expectations for post-op physical therapy — some companies even provide internet-based rehab programs that reduce the high cost of outpatient physical therapy that patients can perform in the comfort of their homes.

"Working with the company has allowed us to increase our patient touches significantly more than we'd be able to do on our own," says Dr. Barnes.

Those numerous interactions are especially important when you take on ownership of commercial payer bundled payments, which pay your facility a set fee for an entire episode of care, beginning when patients schedule surgery and ending 90 days post-op. You pocket the money that's left over after all expenses are paid, but you also take on the financial risk of paying for the care of patients who suffer post-op complications.

Consulting companies can help limit the risk. Dr. Barnes or one of his colleagues receives calls from concerned patients during daytime hours, while the company they work with fields all after-hour calls and instructs patients on how to handle minor issues or alerts one of the surgeons if health concerns need to be addressed immediately.

That 24-hour on-call service eliminates unnecessary emergency room visits for treatment of non-emergent issues that can lead to avoidable readmissions, which ruin quality data and take large chunks out profits out of bundled payments.

4. Standardized protocols

When Dr. Hungerford joined Mercy Medical, he discovered that an individual surgeon's patients might be treated according to 6 different order sets, some of which were years old. Reps from the consulting company the hospital partnered with stepped in to help standardize the processes of care.

When the consultants were first hired, they talked to the program's stakeholders, made recommendations on how to organize the management structure and outlined how information should be disseminated to the clinical care team. Over the course of 6 months, the consultants establish policies and procedures, assisted in the hiring of a program coordinator and consulted with leadership as the program got up and running. Now every team member is accountable and responsible for a specific element of the patient care pathway.

"If you don't have a system in place that ensures everyone understands how their role impacts overall patient care, your program will fail, no matter how intelligent you are or how hard you work," says Dr. Hungerford.

Implant companies that have gotten into the consulting business can provide proprietary implant systems to the facilities with which they work. There's clear self-interest involved in that arrangement, but receiving customized procedure kits reduces the (often significant) number of instrument trays you'll need to perform joint replacement procedures. That eliminates dedicating valuable shelf space to storing the tools and takes some burden off of your reprocessing team.

5. Smart shopping

The company Dr. Hungerford works with is not involved in the facility's daily operations, but does provide analysis support, which includes benchmarking data and quarterly updates about the program's financials, operation performance, patient satisfaction scores and quality indicators.

"Whenever we trial a new product or process, we plug it into the established matrix for a couple months to see how it impacts the data," says Dr. Hungerford. "We know exactly how much they impact our program, or how much they don't."

For example, when a vendor tried to sell the surgeons on a new coagulator that promised to limit the amount of transfusions needed during hip replacements and therefore would have lowered per-case expenses, they discovered transfusion rates didn't drop as promised.

6. Useful data

The data collection provided by Mercy Medical's consulting partner identifies process improvement opportunities, which lets Dr. Hunger-ford's team drive changes they want to make to the episode of care.

Consultants can also provide benchmarking data collected from facilities within their network, so you can compare your costs, outcomes, quality measures and revenues against similar programs. That level of data analysis can help increase revenues, according to Ms. Doucette, who suggests you collect positive quality data for 6 months before establishing bundled payments with commercial payers.

"Negotiating with payers can be challenging for such a high-cost procedure," she says. "You first need to show that your protocols are established and that your outcomes are excellent."

Trust the process

Ms. Doucette suggests you find out how long a consulting company has been supporting total joints programs and the quality outcome they've helped achieve at other facilities. Ask administrators at those facilities to share specific clinical and financial benefits they've realized through the partnership.

"This isn't about how to place implants," she says. "It's about understanding how to improve the overall process of care and enhance the overall patient experience."

Commit to learning from the advice and the data the company provides, says Dr. Hungerford. "If you want value from the partnership, then it'll be worthwhile," he adds. "But if you're going to force yourself to sit through a few meetings and not make improvements to your program, don't bother." OSM