Geisinger Health System’s warranty program for coronary artery bypass surgery, implemented in February 2006, provides one such example of achievable improvements in quality. Geisinger continues to see marked quality improvements after implementing its bypass warranty, improving adherence to a 40-metric list of best practices from 56% to almost 100%.
The emergence of warranties as a means to improve care quality coincides with the expansion of readmissions penalties into the orthopedic arena.
Beginning in FY 2015, CMS will expand readmissions penalties to total hip and knee arthroplasty, which will likely have a far-reaching and costly effect on orthopedic providers. With CMS estimating that 1,228 hospitals will face penalties for above-benchmark readmissions rates in FY 2015, hospitals may need to look to warranty programs as an additional quality-focused strategy to help reduce readmissions.
However, Virginia Mason’s warranty program is limited because it applies only to surgery-related complications but not the device-related failures more common among orthopedic procedures. As seen with once-promising metal-on-metal implants, orthopedic devices can be a significant driver of post-surgical complications or revisions.
Still, large gains can be made by ensuring use of evidence-based protocols for every joint replacement surgery done at the hospital and driving coordination across the care pathway. Since joint replacement involves multiple providers across the hospital, from imaging and orthopedic surgery to rehabilitation, coordinating across specialists is necessary for surgical and post-operative success. Implementing a warranty program can therefore signal a health system’s commitment to clinical excellence through their use of evidenced-based practices for patient care.
New evidence: The 'joint replacement center' bar is going up
Our data team found that length of stay is dropping significantly for hip and knee replacement procedures. See what's contributing to the decline and how your program can improve LOS.