Whether it’s low back pain, carpal tunnel syndrome, or arthritis, musculoskeletal (MSK) conditions are common, affecting more than 50% of people in the U.S.
MSK claims are among the top three costliest conditions for employers and result in 23.2 million lost working days. Employers are increasingly looking to Centers of Excellence (COE) models to reduce costs and guide their employees to high-quality care. According to the Business Group on Health, 92% of employers have adopted COEs for at least one procedure area.
While COEs seem like the perfect remedy for quality and cost in theory, not all are created equal. “The whole concept of a Center of Excellence is misleading—you really need to look at the surgeons who are performing surgery,” according to Jennifer Cook, MD, a board-certified orthopedic surgeon at Florida Joint Care Institute and co-chair of the advisory board at Employer Direct Healthcare.
What Is a Surgeon-First Centers of Excellence Model?
The most significant challenge when it comes to comparing COEs is the question of quality.
Since there is no overarching regulatory oversight of what qualifies a hospital or facility as a COE, determining what quality care looks like isn’t always clear. Plus, health systems, payers, professional societies, and employers often use their own set of criteria.
COEs have traditionally been evaluated at the facility level, but if the surgeons are not being individually vetted, there’s no way to determine whether or not they’re delivering quality care.
While cost would seem to be an obvious indicator of quality, that simply isn’t the case. “The price of services is largely related to the facility’s fee for certain procedures,” Cook explains. “The negotiated payer rates can also vary between hospitals and ambulatory surgical centers.”
Unlike traditional models, a COE that takes a surgeon-first approach screens individual physicians based on their fellowship training, sub-specialization, experience, case volume, and performance, among other areas, which ensures employees have access to quality care and will have a higher probability of an excellent outcome. “I like to think of a true COE model as a ‘surgeon of excellence’ model because if the surgeon is excellent, then they’re going to get the center to be excellent,” Cook says.
Benefits of a Surgeon-First Center of Excellence Model
A surgeon-first COE is a unique model that delivers quality care, improves access, increases the chance of positive outcomes, and provides a better patient experience. Here are 5 benefits of the model.
1. True Quality Care
COEs that evaluate providers based on the facility only have no way to ensure that surgeons are delivering quality care. Those that take a surgeon-first approach, like EDH, vet individual physicians on a stringent set of criteria, including fellowship training, the kind of educational support they provide pre- and post-op, complication rates, surgery avoidance rates, volume of procedures, and more.
Screening for fellowship-trained surgeons is important, for example, because they have additional training, are specialized in certain areas such as hip and knee replacement, and typically perform a large volume of procedures a year. They are more knowledgeable in their area of focus, adept at their sub-specialization, and up-to- date on best practices. As a result, employees will have access to the most qualified surgeons for their individual procedures and will receive the highest quality of care.
“A knee replacement is very different from an elbow replacement so you want a fellowship-trained surgeon who spends an additional training year in a program focusing on the specific area, has become an expert in their field, and knows how to guide the patient through the entire process to get the best outcomes,” Cook said.
Since chronic conditions and lifestyle choices such as smoking are associated with poor surgical outcomes, high-quality surgeons are also more likely to provide education and support about modifiable risk factors and manage the entire episode of care to reduce the risk for complications. At EDH, we ensure all of our surgeons have robust education programs in place.
2. Improved Health Outcomes
Surgical volume is one of the most important criterion for vetting surgeons in a COE network and is associated with better health outcomes.
In fact, research shows higher provider surgical volume is associated with lower ER visits and hospital readmissions, lower rates of revision surgeries and orthopedic specialist visits, and lower costs.
Surgeons who perform a high volume of the same procedure every year are also more likely to tell members whether or not surgery is even necessary and can guide them to more conservative options such as diet, exercise, and physical therapy.
Additionally, the surgeon-first model ensures employees are steered to the best site of care, ensuring optimal outcomes and the best patient experience.
3. Supports Care Access
Most traditional surgical COEs guide members to large, well-known institutions. Yet since top teaching hospitals and academic medical centers are usually located in large metropolitan areas, this facility-based model limits access to care and eliminates quality surgeons who are closer to home.
In many cases, undergoing surgery at a large institution is not associated with an improved outcome. The surgeons are often supervised residents or trainees rather than experienced surgeons. In addition, infection and complication rates are also often higher in large hospitals than they are at local community hospitals and ASCs.
A surgeon-first COE, however, allows employees to take advantage of an expansive network of quality, fellowship-trained, physicians, which ensures equitable access, quality care, and optimal outcomes.
4. Optimal Site of Care
A COE with a surgeon-first approach means physicians are adept at optimizing the site of care by first considering the individual’s needs and then deciding the best facility for the procedure. “These high-quality surgeons are considering whether or not the patient actually needs the procedure, if they are a good candidate, and if they have tried conservative treatment first,” Cook said.
For example:
- Large institutional teaching hospitals: Best for complex procedures such as revision joint replacements, or high-risk patients with multiple medical comorbidities.
- Community-based hospitals and Ambulatory Surgery Centers (ASCs): Best for less complex cases and healthy patients.
- In-office settings: Best for conservative procedures such as injections.
5. Best Surgeon Selection
When people look for surgeons, many rely on word of mouth. In fact, one survey found that 42% of people ask their doctors to make a referral, 29% ask friends, family, and coworkers, and nearly the same (20%) say they’re likely to look online for physician ratings and reviews. While these sources can be helpful for finding doctors with a good bedside manner, the best outcomes are from surgeons with specific experience and training in the procedure patients need. A friend could have had a great experience with a knee surgeon, but that doesn’t mean that same surgeon will perform hip surgeries at the same level.
Others may ask their health insurance company for a referral, but PPO contracts between payers and health systems that have large groups of doctors have “anti-steering clauses” that prohibit them from directing members to specific doctors.
While there’s no shortage of information, unfortunately, there is no unbiased, single way to find individual surgeons based on quality and outcomes data.
With a surgeon-first Center of Excellence model, however, employees can find the best surgeons for their particular case. Suppose an employee needs a knee replacement, for example. In that case, the COE will only work with doctors who are selected based on training and sub-specialization, surgical volume, outcomes data, and patient satisfaction scores. “An excellent surgeon is going to make sure that the facility and everything that happens from start to finish and the patient experience will be excellent,” Cook says.
Opting For a Surgeon-First COE
A Centers of Excellence that takes a surgeon-first approach vets surgeons using a set of criteria which includes training, sub-specialization, volume, and outcomes data to ensure employees find the best surgeon for their individual needs and the best setting for their procedures. This model also provides access to quality care, improved health outcomes, and an optimal patient experience.
To learn more about SurgeryPlus, our surgeon-first COE, contact us today.
