Geisinger health system’s decision to offer a lifetime guarantee on total hip replacements could only be made after reaching quality metrics that would make any hospital proud. Getting to that level of quality is the background story to the health system’s promise to pay any future costs related to its hip replacement procedures.

Geisinger announced recently that it is expanding its ProvenCare Total Hip program by standing behind the costs associated with orthopedic surgeries for a lifetime. The health system will provide a Geisinger Health Plan member who was receiving hip replacement surgery an unlimited time frame for future surgical care and cost that may be needed, explains Michael Suk, MD, JD, MPH, chair of the Geisinger Musculoskeletal Institute and the Department of Orthopedic Surgery.

This is the first time ever that a patient will be afforded the full range of care — both hospital care and device replacement — for future revisions at no charge, he says.

The costs will be shared between Geisinger and Medacta, which provides the medical devices used in the procedures. The guarantee covers the device itself and all hospital costs for as long as the patient remains with Geisinger Health Plan and is treated by Geisinger providers.

The first patient enrolled in the newly expanded program was a 53-year-old woman who underwent successful total hip replacement surgery on Feb. 26, 2018.

“We’re saying to our patients we will provide such a good level of service that we will take care of any problems down the road 20 or 30 years from now. We can say that because we don’t think there will be problems for any significant number of patients because of what we’re doing to ensure the highest level of care in the first place,” Suk says.

The original ProvenCare program covered post-surgery expenses for 90 days, and the 90-day outcomes were favorable enough that Geisinger started looking at what it would take to expand that guarantee to a lifetime.

“When we posed that question, everyone’s immediate reaction was that this was an impossibility. How could you possibly guarantee it for a lifetime?” Suk says.

“For me, I asked why not. What would it take for us to provide a level of care so high, and have the data to show it, so that we could guarantee the results for a lifetime and have that be a reasonable proposition financially?”

Suk determined that a good 90-day outcome could be extended to a lifetime outcome by enhancing factors like patient engagement, encouraging patients to commit to the Geisinger system for future care, and increasing patient access so that Geisinger could intervene sooner than might be typical for hip replacement patients experiencing problems.

The commitment by Medacta to share the expenses was dependent on the data showing that the lifetime promise made sense financially, Suk says.

Geisinger’s good metrics were the result of years of devotion to using clinical evidence to drive best practices, he says. There are certain things that have to be done a specific way every single time, he says, and that can be a difficult message for surgeons who see themselves as more artist than tactician.

“That’s always the main question: What is the clinical evidence behind what you are doing?” Suk says. “The harder part is actually driving your physicians and decision-makers to adhere to those algorithms and processes. It all has to do with driving unwanted variation out of the system.”

Geisinger introduced its ProvenCare program in 2006. The program uses evidence-based bundles and a fixed per-case rate that covers preadmission, inpatient, and follow-up care, including any complications 90 days post-procedure. Then in 2014, Geisinger launched ProvenCare Hip Fracture, Total Hip, Total Knee, and Lumbar Spine.

Suk says that the model, created by Glenn D. Steele, Jr., MD, Geisinger’s CEO from 2001 to 2015, has reduced complications, lengths of stay, and readmissions, and that the result has been increased efficiency and profit. Suk says the program also helps to reduce variation in healthcare by strengthening buy-in from clinicians around best practices.

More information on Geisinger’s ProvenCare model is available online at: https://bit.ly/2vuDIvY.

SOURCE

• Michael Suk, MD, JD, MPH, Chair, Geisinger Musculoskeletal Institute and the Department of Orthopedic Surgery, Danville, PA. Phone: (570) 214-5605.