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Peter Marhofer, MD is one of 38 esteemed faculty joining us at the Third Interdisciplinary Conference on Orthopedic Value-Based Care in Newport Beach, CA, on January 18-20, 2019.

OVBC 2019 Talk #1: Anaesthesia for Shoulder Surgery: Awake or Sleeping?

OVBC 2019 Talk #2: Interscalene Brachial Plexus Blockade: Why, When, How

View Full Schedule Here: OVBC 2019

American College of Perioperative Medicine (ACPM):  Can you share your best advice for motivating your teams?

Marhofer: Never demand more from your team than you are willing to do.

ACPM: Describe your biggest failure. What did you learn from it?

Marhofer: We can learn only from failures. Therefore, every big or small failure should be considered as a chance. There is no progress without failures.

ACPM: In the past 12 months, how have you adapted to new patient experience expectations in the age of consumerism?

Marhofer: I strictly believe that medicine is not only service. Continuous clinical science and translational medicine enables the best therapies for our patients. Open communication with patients (and parents from children undergoing surgery) is an important part that they feel safe and well treated, but medical decisions have to be done by medical doctors.

About Peter Marhofer, MD: Dr. Marhofer is a Professor and Director of Paediatric Anaesthesia at the Medical University of Vienna, Austria. A world expert in the regional space and orthopedic space, his research interests includes regional anaesthesia, ultrasound and local anesthetics. He serves as an editorial member of the British Journal of Anaesthesia and reviewer of several international reputed journals.

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 Nishant Shah, MD is one of 38 esteemed faculty joining us at the Third Interdisciplinary Conference on Orthopedic Value-Based Care in Newport Beach, CA, on January 18-20, 2019.

OVBC 2019 Session Leader: Medacta Regional Anesthesia Cadaveric Lab

OVBC 2019 Non-CME Talk: “Tools & Techniques to Optimize Value in Outpatient and Bundled Joint Replacement Episodes” during Friday’s Lunch Break.

View Full Schedule Here: OVBC 2019

American College of Perioperative Medicine (ACPM): Can you share your best advice for motivating your teams?

Shah: The best advice I have is that we are all in this together. Medicine can seem very compartmentalized and that leads to working alone with poor communication and only looking out for ones’ own interests. What I preach is that we can only take care of the patient, our center, and even ourselves if we work together and lean on each other. It is perfectly all right and even expected that one individual cannot do everything and needs additional support and assistance. The cohesive nature of our teams’ activities always translate into better communication and ultimately fantastic patient care. The patients see it and feel it, and that leads to a better and more fulfilling experience for everyone involved.

ACPM: What’s the best thing you’ve read lately?

Shah: David and Goliath by Malcolm Gladwell.

ACPM: What are your thought about the future of enhanced recovery models in orthopedics?

Shah: I think enhanced recovery is a overarching thought process that needs to be understood and then adopted, as it relates to every specialty within medicine and really even life in general. Specifically for orthopedics, I think one has to understand that orthopedic surgeries involve much more than just the operative course. There are many individuals and health care providers involved on the front end to optimize this patient for the upcoming surgery as well as their postoperative success. Optimization of health, education, and buy in are all part of the process. Then one has to understand all the parties involved in the postoperative course. Enhanced recovery for orthopedics involves a multitude of individuals as well as the patient within a continuum of care that is far more than just the surgery itself.

About Nishant Shah, MD: Shah is a leading authority in the outpatient hip and joint replacement space. He is currently a partner with Midwest Anesthesia and is extensively trained in regional anesthesia. He is the founder of Subsidium Workshops where he teaches multiple hands on workshops for surgeons and anesthesiologists.

REGISTER TODAY for OVBC 2019!

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Desirée Chappell is one of 38 esteemed speakers joining us at the Third Interdisciplinary Conference on Orthopedic Value-Based Care in Newport Beach, CA, on January 18-20, 2019.

OVBC 2019 Talk #1: “Goal-Directed Therapy”

OVBC 2019 Talk #2: “Enhanced Recovery after Surgery: Implementation Strategies”

View Full Schedule Here: OVBC 2019

American College of Perioperative Medicine (ACPM): Can you share your best advice for motivating your teams?

Chappell: The best advice I have for motivating teams is 4-fold: 1. Educate your team, don’t just expect everyone to follow along because you think you have a great idea. If your colleagues and others you are trying to change don’t understand and don’t buy-in to the project, there is little hope of compliance. Share the evidence in a format that everyone can understand and wants to read.  Not everyone wants to read an entire article.  Break it down to the most pertinent information and disseminate among the masses.  2. Create excitement around your project. Catchy titles, giveaways, and themed days actually work.  3. Engage the whole team not just the “leaders.”  Create a constant feedback loop for the team and all who are involved. Ask for opinions even though you may not need them. Team members want to feel part of a greater movement. If there are only a few decision makers and voices aren’t being listened to, your efforts will die off before they even start. 4. EMPOWER your team.  Provide ongoing tools, resources and expertise the team needs to succeed. If they feel ill-prepared to do the job at hand, failure is inevitable.

ACPM: What’s the best thing you’ve read lately?

Chappell: The RELIEF Trial- STOP restricting fluids for the preoperative patient!

https://www.nejm.org/doi/full/10.1056/NEJMoa1801601.

ACPM: What are your thought about the future of enhanced recovery models in orthopedics?

Chappell: I believe that Enhanced Recovery will become the standard of care for Orthopedics and hopefully ALL surgical patients.  The pathways may look a little different but the basic tenets are the same. 1. Preoperative education and preparation, 2.Pain Control 3. Fluid Stewardship 4. DrEaMing after surgery (Drinking, eating and mobilizing). The naysayers believe that because LOS reduction in negligible in this patient population, developing an ER program is not worth the benefit. LOS is a poor indication of successful recovery. If a patient has a new knee, leaves the hospital within 23 hours but their QOL is reduced and/or their recovery is impaired due to complications, it is NOT a success.  ER reduces complications and improves patient satisfaction and outcomes. It’s time to move beyond LOS reduction as the primary motivation for adoption of ER.

About Desirée Chappell, MSRN, CRNA: Chappell is creator and host of the Round Table Blog podcast on TopMedTalk.com. She is the team leader of Enhanced Recovery at Norton Audubon Hospital. A frequent speaker and presenter numerous conferences, Desiree’s passion for the beneficial outcomes of ERAS programs, improved perioperative management and leadership of these areas has been widely shared.

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AnnMargaret MCCraw is one of 38 esteemed speakers joining us at the Third Interdisciplinary Conference on Orthopedic Value-Based Care in Newport Beach, CA, on January 18-20, 2019.

OVBC 2019 Talk: “Employer Driven Healthcare: Early Observations in this Evolving Journey”

View Full Schedule Here: OVBC 2019

American College of Perioperative Medicine (ACPM): What’s the best thing you’ve read lately? 

McCraw: The Ideal Team Player by Patrick Lencioni | What Customers Crave by Nicholas Webb | Start With Why by Simon Sinek (not a recent read, but my “go-to” leadership philosophy).

ACPM: How do you promote innovation within your organization? 

McCraw: Promoting innovation is easier to do when you’re the only private ortho-neuro group left in your MSA of 750,000 people, and you’re surrounded by 45 hospital-employed orthopaedists and 11 hospital-employed neurosurgeons – our survival literally depends on it. We first disrupted our market in 2012 when BCBS SC began to cover outpatient joint replacements in our ASC. Soon after, we began adding spine procedures. The average cost-savings is 15k-$40k per total joint replacement based on the average claims paid by BCBS SC to 3 hospital systems in the area per their own Treatment Cost Estimator. This distinction as the lowest cost surgical provider for complex ortho/spine procedures coupled with excellent outcomes has become our identity. Of course, once you have disrupted a market, you must continue to innovate or be disrupted by the competitors who are always nipping at your heels. To continue thriving, the innovation cycle must become part of the organization’s culture.

ACPM: In the past 12 months, how have you adapted to new patient experience expectations in the age of consumerism? 

McCraw: What Customers Crave by Nicholas Webb is a great resource for this issue. In the previous 12 months, we have focused on reducing the amount of information we’re collecting at the front desk to enhance the intake process; we have initiated an internal PAINLESS (Patients are in Need. Lead Employees Share Solutions.) campaign; and we are in the process of implementing a scheduling platform that will allow patients to self-schedule via an app by Q4 2018.

About AnnMargaret McCraw: McCraw has spent 20 years navigating the intricacies of orthopaedic practice management. She is a national leader and a fierce proponent of cost transparency and disruptive innovation within the healthcare marketplace. In 2012 she obtained the first BCBS contract in SC to cover outpatient joint replacements. To date, her facility performed over a thousand outpatient orthopedic procedures in an ASC setting.

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Dr. Scott Sigman is one of 38 esteemed speakers joining us at the Third Interdisciplinary Conference on Orthopedic Value-Based Care in Newport Beach, CA, on January 18-20, 2019.

OVBC 2019 Talk 1: “PRO-CON: Do we still need a PT for patients undergoing Joint Surgery” (with Kip Schick, PT, DPT, MB)

OVBC 2019 Talk 2:  “Opioid Sparing Orthopedic Surgery”

View Full Schedule Here: OVBC 2019

American College of Perioperative Medicine (ACPM): How Do You Break Silos In Your Organization?

Dr. Sigman: Specifically, within orthopedics with the use of more expensive non-opioid medications, we found that pharmacy silos give us severe limitation in the ability to use these medications at a number of hospitals across the country.  Our focus has been to try and carve out the use of these medications, so that insurance companies will pay for these medications outside of the typical DRG or payment for an individual surgery.  We did this specifically by lobbying congress as well as CMS, both in person in Washington, D.C. as well as through letter writing campaigns.  We were fortunate to hear that as of January 1^st some of these changes will be implemented going forwards through CMS.

ACPM: In the past 12 months, how have you adapted to new patient experience expectations in the age of consumerism?

Dr. Sigman: I am a huge believer in social media.  I have postings on Linkedin for my business friends.  I am also on Facebook for my older population of patients as well as  Instagram for my younger population of patients.  I remain connected with my patients.  With these avenues, we can express the latest state of the art techniques that we are performing and in engaging patients directly, we have found that we have great success.

ACPM: Surgeries moving to the outpatient area.  How do you get ready for it?

Dr. Sigman: This has been the natural progression for us in the opioid sparing space. We are now successfully operating on patients near opioid free, which opens up the realm of possibility for outpatient surgery for even more extensive operations such as  total hip and knee replacements as well as outpatient spine surgery.  The patient expectations as well as patient selection I think are paramount to make sure that you have the best chance of success for patient experience.

About Scott Sigman, MD: Sigman is an orthopaedic surgeon specializing in Sports and has served as Team Physician for the US Ski Jump Team, and serves for the last 20 years as Team Physician at UMASS Lowell. He is the Chief of Orthopaedics at Lowell General Hospital and is considered a national authority in Opioid Sparing Surgery. He has contributed to numerous publications and research studies on advances in orthopaedic surgery.

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Dr. Vaccaro is one of 38 amazing speakers joining us at the Third Interdisciplinary Conference on Orthopedic Value-Based Care in Newport Beach, CA, on January 18-20, 2019.

OVBC 2019 Talk: “Replace the Surgeon? Robotics in Orthopedics & Spine Surgery”

OVBC 2019 Panel Participant: “Volume to Value Panel: Perspectives of Private Practice, Supergroup, Academia and Integrated Care System.”

View Full Schedule Here: OVBC 2019

American College of Perioperative Medicine (ACPM): Can you share your best advice for motivating your teams?

Dr. Vaccaro: Make sure they clearly understand goals and objective of any initiatives and have the opportunity for feedback and buy in. Show that you care about them and their opinions, be humble, celebrate/ recognize/ reward small and large wins, roll up your sleeves.

ACPM: How do you break the silos in your organization?

Dr. Vaccaro: Communicate, Communicate, Communicate. Reward the Management team based on team goals/ targets so that it incentives to work “across lines/ departments”. Have each leader “walk in the other’s shoes” so they get a better understanding of the position, responsibilities, problems/issues, work product. Constantly motivate, meet as a leadership team often, teak the team to dinner/drinks – get to know each other personally.

ACPM: Surgery is moving to the outpatient area; how do you get ready for it?

Dr. Vaccaro: Develop OP ASC’s (we now have 8 – and will got up to 12-14 with Northern Jersey and NY). Larger OR’s and PACU bays; risk assessment all patients for appropriateness of care, visit existing ASC’s that are performing Spine/Joints on an OP basis. Define specific criteria for cases qualifying for OP ASC. Ensure that the OR’s are big enough.

About Alexander R. Vaccaro, MD, PhD, MBA: In addition of being President of Rothman Institute, Vaccaro is Professor and Chairman of Orthopaedic Surgery at Thomas Jefferson University. He is the past President of the American Spinal Injury Association. He has over 650 peer reviewed publications and is the editor of over 54 textbooks and co-editor of OKU-Spine I and editor of OKU-8.

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Written by Laura Dyrda

Repost; Originally Published on November 19, 2018 by: Becker’s Spine Review 

Registration is open for the American College of Perioperative Medicine’s Interdisciplinary Conference on Orthopedic Value-Based Care.

The conference, which takes place Jan. 18-20, 2019, in Newport Beach, Calif., spans three tracks and includes 38 faculty members who will speak on value-based payments, enhanced recovery after surgery, MACRA, MIPS and the Comprehensive Joint Replacement program. Chaired by Zeev N. Kain, MD, president of ACPM and chancellor professor at UC Irvine Health, the event is designed as an “immersion weekend” to cover the team approach to orthopedic care.

Experts from across the field, including orthopedic surgeons, nurses, physical therapists, anesthesiologists, healthcare executives, patients and futurists will be speaking. The event also includes a day focused on outpatient surgery and ASCs.

“The idea of this conference is to break the silos in the orthopedic space,” said Dr. Kain. “This is the third year of the meeting and we have a top-notch speaker agenda who see this as a very important concept. Many are coming in teams of three or more to take advantage of our three parallel tracks: operational, clinical and financial aspects of orthopedics and spine.”

Read the rest of the article at Becker’s Spine Review.

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