A Guide to Building a Joint Replacement Center of Excellence

What exactly does it mean to be a joint replacement center of excellence and how can a hospital or care center become one? By definition, a center of excellence (sometimes called a COE) is an established collective of physicians and administrators that band together to commit to delivering the highest quality of care in a specific specialty. Hospitals adopt the designation “center of excellence” to publicly highlight and market expertise and dedication to a focused clinical service, like joint replacement surgery. As the term “center of excellence” continues to become more widely understood by physicians and patients alike, establishing your care center as “excellent” becomes an increasingly valuable means to stay at the top of the game.

Centre of Excellence in Joint Replacement Surgery

This is where things get interesting: there is no regulatory board or standardized requirement that determines who should or should not make the cut when it comes to being an Orthopedic Centre of Excellence. In other words, as it currently stands the criteria for excellence is a bit of a grey area. It’s kind of like publicly sharing that you got a superb test score—only you got to create the test and grade it yourself. In saying this, things are quickly changing. Some specialities, like bariatric surgery, have developed a standard criteria that all hospitals across the country must meet in order to be recognized as as Center of Excellence in Metabolic and Bariatric Surgery (COEMBS).

Coming up with unbiased, legitimate requirements for your own hospital’s Center of Excellence can be uncovered by looking at the Joint Commission certification as well as other regulated Center of Excellence programs. Building a Center of Excellence the right way, the first time around, will let you stay ahead of the curve and pass with flying colors when an inevitable, nation-wide standardized eligibility criteria for the joint replacement speciality is enforced.

Read on as we share what factors we think should go into your hospital’s “Center of Excellence” requirements. But before we do, let’s touch briefly on the why it’s a great idea to join the “Club du Excellence” (this is french for, you know, the Center of Excellence).

3 Reasons Why Your Hospital Should be a Center of Excellence

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Win More Patients and Physicians: Market a Cut Above

Becoming the leading regional, national or international joint replacement center is the number one reason for striving for an earned spot as a recognized Center of Excellence. With this title, comes an opportunity for great marketing. After all, patients seeking out a hip or knee replacement and talented physicians are attracted to the best in class. Building a renowned joint replacement specialty program stands out in any community--even on the world stage. A world-class joint replacement program attracts new patients in a competitive marketplace as well as top-tier talent that provide the necessary skills for maintaining a leading orthopedic program. It helps you market your institution as a cut above in a sustainable way that the community trusts.

Strategically Creates a Better Specialty Program

It’s important to distinguish the legitimate Center of Excellence programs from those that have adopted the recognition as nothing more than an empty marketing tactic. Putting a gold banner on website and tossing around the accreditation title without actually building a strategy and vision to better serve patients with influential care providers, doesn’t count. Real centers of excellence are not just high volume programs with good outcomes, they are excellent institutions that work to attract and retain the best talent from top to bottom.

A great joint replacement Center of Excellence program amalgamates the best of the best that a community has to offer to deliver the highest level of care. Often times, this means combining the forces of private practices or physician groups with hospitals. Most often, this is where a successful private practice or group of orthopedic surgeons become employees of a hospital. Once acquired by the hospital system, top administrators and physicians work together to build out an infrastructure that demands growth and improvements to care quality, assigning roles and engaging key players throughout the system. In these developed strategies, contractual agreements that require things like advanced credentialing of care providers and administrators are laid out.

As a result, joint replacement programs that have been strategically built are more transparent, goal and growth-oriented, and have open lines of communication from the front line to the c-suite. It creates a unified culture of excellence.

To highlight what a tried and true joint replacement COE looks like, check out the orthopedic program at Rush University Medical Center. Rush’s orthopedic program is an example of a COE that’s earned its title.

Higher Quality of Standardized Care

In the same vein as developing a stronger joint replacement program, being a center of excellence means pledging for and building a continuum of care around quality. As healthcare in the US continues to shift away from the traditional fee-for-service model into compensation models that are based around quality of care delivered, locking in a Center of Excellence plan becomes two-fold. With a great overlap in the measures and reporting suggested in leading COE programs proactively adopting a system that forces improved quality, reporting, resource use, advancing care and clinical practice improvements, eases hospitals and clinicians into the mandatory changes ahead with bundled payments, MIPS, MACRA and other APMs.

A solid Center of Excellence program follows set requirements for success and a day-to-day clinical flow that delivers excellent care. A specialty program designed around quantifiable measures like having a fixed number of staff accredited in continued learning programs, requiring surgeons to perform a minimum number of cases to be brought into the system, reporting patient satisfaction etc., supports a higher quality of care. This not only standardizes the care a physician delivers and a patient receives, but also aids in the reporting and collecting of valuable data.

Building an Orthopaedic “Center of Excellence”

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Using the certification requirements set out by the Joint Commission and looking at other leading Joint Replacement Centers of Excellence--like Cleveland Clinic, Rush, and the Hospital for Special Surgery--here’s what we think your program should be built upon.

1. Clear, Cohesive Leadership

A strong partnership between hospitals and physician groups are the core of any successful speciality program. A clear organizational structure built around this partnership is key for the successful planning and operation of a Center of Excellence. Defined roles and contractual agreements better ensure that key players are involved and understand where they fit into the larger picture. Appointing influential program directors--both in administration and amongst the physician group--creates champions who will maintain support and help the program grow.

Duties for physician program directors should include:

  • Participate in the relevant decision-making administrative meetings of the facility.
  • Be primarily responsible for coordinating the multidisciplinary services and systems for orthopedic surgery.
  • Participate in multidisciplinary team meetings.
  • Create gainsharing programs to align physicians and the hospital.

2. High-Standard of Surgical Experience

Defining an annual minimum case load for orthopaedic surgeons keeps quality high and allows specialists to remain at the top of their field. For reference, the average surgery caseload for a full-time orthopedist in the US is 384 per year. In order for a physician to be brought into the program, a minimum determined volume for specific procedures should be established. Setting the procedure types and outcomes required to qualify for your specialty program can be used for better year-end reporting, marketing material, as well as towards other mandated Medicare models.

3. Complete In-House Services

Your care center must must be able to accommodate all of the routine and intensive care of orthopaedic surgery patients.

Staffwise, this should include, but is not limited to:

  • Orthopaedic surgeons
  • Nurses
  • Nurse navigators
  • Anesthesiologists
  • Program managers
  • Nutritionists
  • Mental health provider
  • Physical therapist and/or occupational therapist

Providing complete in-house care before surgery through to discharge is a basic necessity. This includes having a fully-equipped facility with all necessary equipment for prehab, surgery and rehab.

Identifying all players needed for complete in-house service is an early, foundational step to building a successful program.

4. Standardized Operating Procedures

Setting clinical pathways that facilitate the standardization of care means that when staff follow the appropriate defined measures, high quality care and service will be achieved. Setting clinical process guidelines creates consistency, reduces complication and error risk, and boosts patient satisfaction. Ideally, this would mean that patients across the board would have very similar experiences from surgery preparation and Prehab through to recovery and ReHab.

Tips for Standardizing Care and Clinical Flow

  • Employ a nurse navigator who will guide patients through each phase in their episode of care. Nurse navigators serve as the mediator between the patient and clinicians and administration.
  • Set up patients with the same pre-operative and post-operative PreHab and ReHab program. A mobile app, like PeerWell, ensures patients are in optimal health on surgery day and guides them throughout the first 90 days of recovery. Care teams can monitor patient progress with easy-to-analyze data.
  • Hold quarterly meetings with physician directors, executives, care staff, and administrative to discuss holes in clinical flow, inconsistencies, how goals are being met and so forth. A diverse, comprehensive meeting agenda should involve updates and discussion from key players in all departments.

A major part of standardizing procedure in order to attain excellence consistently, is setting key performance measurement requirements and collecting performance data. Here is more information by the Joint Commission about identifying performance indicator measures.

5. Patient Education and Support

Your hospital or clinic must provide engaging, comprehensive preoperative patient education. This means investing in a proven PreHab program that gets patients ready for hip or knee replacement surgery--mentally, physically and environmentally. Guiding patients through the pivotal time period before surgery should be incorporated into your program strategy as it targets quality improvement, solves for standardized care, improves surgery outcomes and creates greater patient satisfaction.

In addition, a leading PreHab program, like PeerWell, should offer greater support to patients as they prepare for their scheduled procedure and recovery. This means giving patients a level of preop and postop care that clinicians and admin typically do not have the bandwidth for. An automated, daily patient PreHab and Rehab program that’s introduced by clinicians can drastically improve the level of patient satisfaction that a patient attributes to the surgeon and hospital.

How PeerWell Helps You Become a Centre of Excellence for Joint Replacement Surgery

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  • Aligns Goals and Interests of Admin, Clinicians and Patients—PeerWell is the surgeon-preferred PreHab program and patient engagement app. Program goals are unified when patients are healthier and more prepared for surgery; when clinicians save time while engaging more with patients; and admin can oversee higher quality of care that exceeds performance standards.
  • Standardizes Care to Serve Better and Save Time—PeerWell’s complete smartphone PreHab and ReHab program guides patients through all of the cutting-edge, medically proven activities and education that lowers complication risk, improves surgery outcomes, and speeds up recovery. Each patient receives the same level of guidance and information for the weeks leading up to surgery and throughout the first 90 days post-op. * Improves Patient Satisfaction—PeerWell works to offer patients white-glove service that boosts patient satisfaction and feelings of peer and professional support. Because PeerWell is customized and co-branded with the hospital or surgeon’s office, patient satisfaction is automatically attributed to your care center.
  • Improves Patient Education—Without clogging admin or clinician time and resources, PeerWell breaks down the information, exercises and advice that are most impactful for patients. Without any heavy IT integration or bureaucracy, patients are better prepared and well-versed for surgery, automatically.
  • Contributes to Marketability—Let's face it, mobile apps are cooler than pamphlets or classes. A comprehensive PreHab and ReHab program delivered in daily, interactive lessons brings your institution up to speed with the times, helping you market your care center as a modern, cutting-edge leader.
  • Boosts Care Quality and Outcomes—PeerWell was designed to facilitate higher levels of attentive care between patient and provider. PeerWell positively contributes to the performance quality and reporting measures Medicare now requires under bundled payments, MACRA, MIPS and CJR.

Are you a hospital administrator or executive interested in learning more about PeerWell—the PreHab program sweeping across hospitals from coast to coast? Sign-up and we’ll be in touch.

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Hi, I'm Grace. I write all things surgery for the PeerWell blog. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement".

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