Samuel Gold, Technology Insights
A huge number of hospitals offer joint replacements because the aging population increases demand, there are few capital purchases needed, and reimbursement has been historically favorable.
In fact, approximately two thirds of acute care hospitals in the United States performed joint replacements in 2012. Therefore, the level of competition for joint replacement volumes is very high and with the low barrier to entry into this business, competition continues to grow.
As hospitals seek to gain a competitive edge in this elective arena, they have directed their attention towards programmatic changes designed to improve the patient experience during each stage of a joint replacement surgery.
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In addition to launching our national meeting series at the end of April, we’re also offering a series of webconferences across the coming months. These webconferences will focus on the outlook for key service lines, providing an overview of key trends in volumes and examining strategies that hospitals can use to continue to transform and grow particular service lines.
The series begins with orthopedics on March 20—we encourage Marketing and Planning Leadership Council members to register today. We’ve included more details, including links to the webconferences, below.
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We often receive questions about pediatric-specific service line strategies. In many cases, the same tactics that hospitals use to drive referrals to service lines more generally apply to growing pediatric volume.
In a recent Expert Insight piece on strategies for growing pediatric orthopedic programs, we outlined how many of the strategies mirror broader approaches to orthopedic service line growth. That said, while many of the tactics may be similar, successfully applying them to pediatric orthopedics growth requires some nuanced implementation.
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Eric Cragun, Marketing and Planning Leadership Council
In recent decades, nearly all American hospitals have adopted the product portfolio strategy of subsidizing less profitable, mission-driven services with moneymakers such as interventional cardiology and spine surgery. While those “profit sanctuaries” are by no means vanishing, the announcement that CMS audit contractors will be scrutinizing certain high-end services is the latest, and perhaps the biggest, near-term threat to hospital product strategy in quite some time.
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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.
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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 (email@example.com) 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.
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