We regularly hear from hospitals seeking to better engage physicians in quality improvement and utilization management efforts. At a service-line level, hospitals have seen some success increasing physician engagement through co-management arrangements. Co-management arrangements pay physicians at fair-market value for administrative responsibilities and provide additional incentive payments based on achievement of quality and cost goals.
Hospitals find this alignment model to be particularly attractive for orthopedics service lines, given the independence of orthopedic surgeons and the substantial potential for both quality gains and cost reduction within orthopedics. In a survey of 258 hospital and health system leaders, 11% reported co-management of orthopedics service line, the third highest among service lines after cardiology (13%) and imaging (12%). Tight alignment with orthopedic surgeons will be even more critical as hospitals seek to balance two competing influences on volumes: Demographics will drive growth of joint replacement even as scrutiny of appropriateness increases.
Co-management models especially promising for orthopedic service lines
We just debuted a new resource for Marketing and Planning Leadership Council members: the Service Line Forecast Compendium offers downloadable and online snapshots to help members assess growth prospects for key service lines. We’ve designed the compendium—which consists of a two-page document for each of the featured service lines—to be a quick reference for our members. The Compendium is just one of several resources that we using to further the work of our Service Line Transformation Initiative.
The Compendium snapshots provide information on growth of both the overall service line and individual procedures. In addition to quantitative forecast figures, the capsules also offer qualitative assessments of drivers and barriers of growth that influence Advisory Board forecasts.
In this first round, we’ve developed the documents for cardiac services, vascular services, orthopedics, and neurosciences service lines. We plan to add snapshots for oncology, imaging, and women’s services in the near future. Are there other service lines for which you’d like to see a capsule? Email Eric Cragun (firstname.lastname@example.org) with any suggestions.
Another question we recently received with regard to geriatric services is: What about building an osteoporosis screening and/or fall prevention clinic?
As hospitals turn to preventive and screening services to improve utilization management and increase upstream market share, screening for osteoporosis and efforts to prevent falls offer an option for reducing fracture rates among frail, elderly patients. Estimates suggest that half of women are at risk of osteoporosis-related fractures during their lifetime.
The U.S. Preventive Services Task Force (USPSTF) issued guidelines earlier this year that gave a “B” recommendation to osteoporosis screening for women ages 65 or older and younger women with fracture risk factors. Though the report concludes that “No controlled studies have evaluated the effect of screening for osteoporosis on fracture rates or fracture-related morbidity or mortality,” it still finds enough evidence to conclude that drug therapies reduce the risk of fractures and that “the benefit of screening-detected osteoporosis is at least moderate” for women. The USPSTF did not find enough evidence to recommend osteoporosis screening in men, who are at lower rates of osteoporosis-related fractures. Similarly, in a draft statement, USPSTF gave a “B” recommendation to some falls prevention efforts.
Evaluating an osteoporosis screening program