Becker's Spine Review

48 HEALTHCARE NEWS Walmart's centers of excellence program cut joint replacement costs by 15% — 5 things to know By Angie Stewart W almart's centers of excellence program, which pays for employ- ees to travel and receive care at designated facilities, was expanded in 2014 to include hip and knee replacements. In 2018, Walmart implemented a 50 percent copay for employees who received joint re- placements outside the COE network. e change caused COE utilization to spike 113 percent, although charges were waived for emergent and urgent conditions. Harvard Business Review examined the pro- gram's success. Five things to know: 1. From 2015 to 2018, 1,836 Walmart associ- ates had joint replacement surgery at a COE site, constituting 18 percent of all employees who underwent the procedure in that time- frame. About two-thirds of those patients were women, and most were 50 to 64 years old. COE specialists determined 20 percent of patients wouldn't benefit from surgery. 2. Because COE patients had better out- comes and avoided unnecessary procedures, Walmart's cost per case was about 15 percent lower at COE sites than at non-COE hospitals. e cost for joint replacements at COEs was $23,505, compared with $27,721 at non-COEs. 3. Patients spent about 1.7 days in COE hospi- tals, 32 percent less time than patients who went to hospitals outside the program. COE patients returned to work aer 11.3 weeks, a week and a half sooner than non-COE patients. 4. COE joint replacement patients had fewer postsurgical complications and were 70 per- cent less likely than non-COE patients to be readmitted to a hospital. None of the COE patients required care in a skilled nursing facility aer discharge, compared with more than 5 percent of patients who received care outside the network. 5. e article's authors include Lisa Woods, head of Walmart's U.S. benefits design and strategy; neurosurgeon Jonathan R. Slotkin, MD, who serves as spine surgery director at Danville, Pa.-based Geisinger Neuroscience Institute and associate chief medical informat- ics officer at Geisinger Health in Danville; and Health Design Plus founder Ruth Coleman. n BPCI Advanced loses 252 providers, 35% of lower extremity major joint replacement participants By Angie Stewart T he Bundled Payments for Care Improvement Ad- vanced Program has seen a 16 percent drop in participants since October 2018, CMS reported. Four insights: 1. The program lost 252 Medicare providers, down from 1,547 participants when the program began in October. There are now 715 acute care hospitals and 580 physician group practices participating in BPCI Ad- vanced. 2. The BPCI Advanced model includes 1,086 contracts in its second year, down from 1,299 in October. 3. Providers can opt in for 29 inpatient and three out- patient clinical episodes, receiving payments based on performance during a 90-day episode of care. 4. The number of participants in the bundled model for major joint replacement of the lower extremity dropped about 35 percent, according to Healthcare Finance. n Vanderbilt hit with $25.5M suit over wrong-site surgery By Mackenzie Bean A Tennessee woman filed a lawsuit against Nash- ville-based Vanderbilt University Medical Center March 19, claiming surgeons operated on her wrong kidney, reported The Tennessean. Carla Miller sought care at the hospital in November 2017. The suit claims surgeons implanted a 22-centimeter stent in her right kidney instead of the left and ran it up the wrong side of her body. Ms. Miller's attorney, Afsoon Hagh, said the medical error damaged Ms. Miller's urinary system and now requires her to receive dialysis for life. "For a wrong-site surgery to occur, there has to be a signifi- cant series of breakdowns and errors by multiple healthcare providers," Ms. Hagh said in a statement to The Tennessean. "The fact that such a chain of missteps occurred here is very concerning." The lawsuit is seeking $25.5 million in compensatory and pu- nitive damages. A Vanderbilt spokesperson told Becker's the hospital does not comment on pending litigation. Ms. Miller's lawsuit comes nearly two months after a Vander- bilt nurse was indicted on a reckless homicide charge over a fatal medication error made in December 2017. n

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