Improving clinical and economic value in today's ...synthes.vo.llnwd.net/o16/LLNWMB8/US...

Improving clinical and economic value in today's healthcare environment

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Agenda

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Total knee arthroplasty (TKA): volume and economics

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The impact of osteoarthritis (OA) is growing

The prevalence of osteoarthritis in the US is increasing with an aging and increasingly obese population.

Symptomatic OA imposes a serious burden that leads to higher healthcare costs—including increased rates of TKA.1-4

References:

1. Weinstein AM, Rome BN, Reichmann WM, et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am. 2013;95:385-392.

2. Ickinger C, Tikly M. Current approach to diagnosis and management of osteoarthritis. S Afr Fam Pract J. 2010;52(5):382–390.

3. Breedveld FC. Osteoarthritis—the impact of a serious disease. Rheumatology. 2004;43(suppl 1):i4–i8.

4. Mehrota C, Remington PL, Naimi TS, Washington W, Miller R. Trends in total knee replacement surgeries and implications for public health, 1990–2000. Public Health Reports. 2005;120:278-282.

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Over half of US adults 50+ with symptomatic knee OA will undergo TKA1

The demand for TKA is very high and growing—especially in younger demographics.1

Approximately 1 in 10 women and nearly as many men will eventually receive a TKA.1

This increase in rate of procedures will need to be addressed through increased institutional capacity to perform TKA.

Reference:


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TKA increasing in volume and efficiency

Over the past ~20 years volume of TKA surgeries among Medicare beneficiaries has increased over 150%, with Medicare patients comprising the majority of TKA patients.1,2

Over the same period of time, there has been a corresponding decrease in LOS by more than half.1

At a daily cost of ~$2000 on average per inpatient day, the cost savings realized by decreased LOS is significant. 3

References:

1. Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010. JAMA. 2012;308:1227-1236.

2. Barnes CL, Vail TP, Takemoto SK. Where do knee revisions for infection, fracture, and other revisions get treated? J Arthroplasty. 2013;28:423-428.

3. Kaiser Family Foundation. kff.org/other/state-indicator/expenses-per-inpatient-day/#. Accessed June 24, 2014.

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Changing economic factors in TKA

The manufacturer prices for TKA have decreased by 17% as payments from CMS for TKA have increased by 6.8%.1,2

References:

1. Long G, Mortimer R, Sanzenbacher G. Recent average price trends for implantable medical devices, 2007-2011. Analysis Group, Inc. September 2013.

2. Data on file. Data calculated from the Medicare acute inpatient reimbursement schedules for DRG code 470, years 2010‐2014.

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Hospitals will need to adapt to meet changing economic landscape for TKA1-3

TKA could potentially be a loss leader if hospitals don't address economic factors today.

Among the factors that impact payments and penalties for TKA are bundled Medicare payments, increasing penalties for 30-day readmissions above the national average, and pay-for-performance metrics that factor in patient satisfaction.1-3

References:

1. [Editorial] What does one minute of operating room time cost? J Clin Anesthesia. 2010;22:233-236.

2. Medicare Payment Advisory Commission. June 2013.

3. HCAHPS Fact Sheet, August 2013. www.hcahpsonline.org/Facts.aspx. Accessed April 15, 2014.

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Where do you stand?

Let’s look at how your institution compares to the national averages in these areas that impact payments and penalties—30-day readmission rate, LOS, and patient satisfaction with pain control?

References

1. US Dept of Health and Human Services; Centers for Medicare & Medicaid. Hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and proposed fiscal year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation. Federal Register. 2013;78(91):27486-27823.

2. Centers for Medicare & Medicaid Services. 100% MEDPAR inpatient hospital national data for fiscal year 2011; short stay inpatient diagnosis-related groups. www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareFeeforSvcPartsAB/downloads/DRG11.pdf. Accessed August 5, 2014.

3. Medicare.gov Hospital Compare [database online]. Baltimore, MD: Centers for Medicare & Medicaid Services. Accessed August 5, 2014.

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The ATTUNE® Knee System: Designed for improved performance, patient satisfaction, and OR efficiency

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The ATTUNE® Knee System: the culmination of an extensive development program

DePuy Synthes is committed to meeting unmet clinical and economic needs to the benefit of all stakeholders through patented, clinically proven innovations designed to improve outcomes without increasing costs.1,2

References:

1. Data on file. DePuy Synthes. Warsaw, IN.

2. Callaghan JJ, Wells CW, Liu SS, Goetz DD, Johnston RC. Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of twenty years, of a previous report. J Bone Joint Surg Am. 2010;92(7):1635-1639.

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The ATTUNE® Knee System: the culmination of an extensive development program

DePuy Synthes is committed to meeting unmet clinical and economic needs to the benefit of all stakeholders through patented, clinically proven innovations designed to improve outcomes without increasing costs.1,2

References:


2. Callaghan JJ, Wells CW, Liu SS, Goetz DD, Johnston RC. Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of twenty years, of a previous report. J Bone Joint Surg Am. 2010;92(7):1635-1639.

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The ATTUNE® Knee System: Designed to address instability

Compared with other leading knee systems, the ATTUNE® Knee System minimizes abrupt changes, which have been shown to adversely impact implant stability.1-3

Instability is one of the leading reasons why up to 20% of patients are not satisfied after TKA.4,5

References:

1. Sathasivam S, Walker PS. The conflicting requirements of laxity and conformity in total knee replacement. J Biomechanics. 1999;32:239-247.

2. Fitzpatrick CK, Clary CW, Rullkoetter PJ. The influence of design on TKR mechanics during activities of daily living. Poster presented at the 58th Annual Meeting Orthopaedic Research Society; 2012; San Francisco, CA.


4. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. JBJS-Br. 2007;89-B(7):894-900.

5. Bhandari M, Smith J, Miller LE, Block JE. Clinical and economic burden of revision knee arthroplasty. Clin Med Insights Arthritis Musculoskelet Disord. 2012;5:89-94.

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The ATTUNE® Knee System: Designed to address poor implant fit

Compared with most other knee systems, the ATTUNE® Knee System offers more sizes, which helps improve implant fit.1-5

This wide range of sizes is possible with 66% fewer SKUs vs Zimmer Persona™—which can help free up shelf space and ease burden of staff training.1,5

References:

1. Zimmer Inc. Persona: The Personalized Knee System. Product Profiler. November 26, 2012.

2. Stryker Inc. Triathlon Knee System Product Catalog. 2004.

3. Biomet Orthopedics Inc. Vanguard Knee System. Design Rationale. 2007.

4. Smith & Nephew Inc. Journey II Surgical Technique. 2013.


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The ATTUNE® Knee System: designed to address anterior knee pain1

The ATTUNE® Knee System is one of only two knee systems with an offset medialized design that mirrors the native knee patella.2-6 This offset medialized design may decrease the risk for patella issues.1

In early outcomes data, the ATTUNE® Knee System has demonstrated reductions in pain compared with the leading knee system.6,7

References:

1. Clary CW, Wright AP, Komosa MC, Maletsky LP. The effect of patella medialization on patellofemoral kinematics after total knee replacement. Presented at the 18th European Society of Biomechanics, Presentation No. 1262, Lisbon, Portugal. 2012

2. Zimmer Inc. Persona: The Personalized Knee System. Product Profiler. November 26, 2012.

3. Stryker Inc. Triathlon Knee System Product Catalog. 2004.

4. Biomet Orthopedics Inc. Vanguard Knee System. Design Rationale. 2007.

5. Smith & Nephew Inc. Journey II Surgical Technique. 2013.


7. National Joint Registry for England, Wales and Northern Ireland. 10th Annual Report. Hemel Hempstead, UK: National Joint Registry; 2013.

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ATTUNE® Knee INTUITION™ Instruments: designed for OR efficiency

The ATTUNE® Knee System provides intuitive instrumentation and a comprehensive range of sizes for precise control over fit and position.

Red actuators, high-contrast markings, and quick set/release functions are clear and easy to use and may streamline efficiency in the OR.

Fewer, lighter instruments in single-layer cases reduce weight by 51%, which may help you meet staff safety guidelines around manual handling of heavy objects.1,2

References:


2. Health and Safety Executive. Manual Handling at Work: A Brief Guide. http://www.hse.gov.uk/pubns/indg143.pdf. November 2012. Accessed July 31, 2014.

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TRUMATCH® Personalized Solutions help enhance efficiency and manage costs

Digital templating and patient‐specific instruments may help realize efficiencies in the areasof pre‐op imaging, set‐up, and OR time.1‐3

TruMatch® Personalized Solutions has helped surgeons design more than 20,000 patient‐specific plans worldwide3

References:

1. White D, Chelule KL, Seedhom BB. Accuracy of MRI vs CT imaging with particular reference to patient specific templates for total knee replacement surgery. Int J Med Robotics Computer-Assisted Surg. 2008;4:224-231.

2. Watters TS, Mather RC III, Browne JA, Berend KR, Lombardi AV Jr, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthopaedic Adv. 2011;20:112-116.


4. What does one minute of operating room time cost? [editorial] J Clin Anesthesia. 2010;22:233-236.

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Digital templating streamlines pre‐op planning and OR time

Digital templating may help realize efficiencies in the areas of pre-op planning, instrument trays, and OR time.1,2

In one study comparing 82 knee cases with and without digital templating, digital templatingsaved ~$9612 over 1 year due to cost reductions in tray processing and radiographs.2

References:

1. Altenburg A. [White paper.] Efficiency in total joint arthroplasty. DePuy Orthopedics: Warsaw, IN. 2012.

2. Hsu AR, Gross CE, Bhatia S, Levine BR. Template-directed instrumentation in total knee arthroplasty: cost savings analysis. Orthopedics. 2012;35(11):e1596-e1600.

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DePuy Synthes: services and programs for institutions

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DePuy Synthes Advantage™: a suite of services focused on clinical and economic outcomes

DePuy Synthes Advantage™ offers a suite of services designed to help you drive demand,create capacity, maximize resources, and improve performance.

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DePuy Synthes Advantage™ services add value to your institution

The Data Tracker App helps assess your institution’s TKA efficiency.

The Safe Surgery Initiative is an innovative Web-based education program that engages patients, providers, health plans, and employers to collaborate on healthcare quality.

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DePuy is invested in long-term partnerships with hospitals and surgeons to create better products and services that provide better value, for better outcomes for patients.

• CareSense* tracks patient performance scores and data for the ATTUNE® Knee System

• Patient Ambassador program leverages word-of-mouth referrals by equipping satisfied ATTUNE® Knee System patients to share their successful outcome with other potential patients

*Fee-based service.

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DePuy is invested in long-term partnerships with hospitals and surgeons to create better products and services that provide better value, for better outcomes for patients.

• CareSense* tracks patient performance scores and data for the ATTUNE® Knee System

• Patient Ambassador program leverages word-of-mouth referrals by equipping satisfied ATTUNE® Knee System patients to share their successful outcome with other potential patients

*Fee-based service.

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DePuy Synthes companies

The DePuy Synthes Companies have been innovating and discovering for over 100 years and offer the world’s most comprehensive portfolio of orthopedic and neuro products.

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Working with you to improve outcomes and reduce costs

To help you address the increasing demand for TKA, DePuy Synthes is committed to working with you to improve outcomes and increase efficiency.

The ATTUNE® Knee System addresses issues that impact patient satisfaction and enhance hospital efficiency through digital templating and the use of patient-specific instruments.

Additionally, DePuy Synthes offers a suite of services to partner with you to make a difference at your institution.

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Appendix

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Patient satisfaction impacts Medicare incentives and penalties

Pain is the leading indicator for patient dissatisfaction after knee replacement.1

Pain management is 1 of 8 HCAHPS* measures that determine Medicare performance-based incentives and penalties.2

*Hospital Consumer Assessment of Healthcare Providers and Systems.

References:

1. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. JBJS-Br. 2007;89-B(7):894-900.

2. HCAHPS Fact Sheet, August 2013. www.hcahpsonline.org/Facts.aspx. Accessed April 15, 2014.

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TKA-specific Medicare penalties are substantial1,2

Starting October 2014, Medicare will charge hospitals $278,000 for each excess readmission above the U.S. average of 5.4%.The readmission penalty for TKA is higher than the penalty for heart failure, heart attack, pneumonia, or chronic obstructive pulmonary disease (COPD).

References:

1. Sources and math underlying the penalties. http://www.globe1234.info/medicare/readmissions. Accessed August 6, 2014.

2. Federal Register. Department of Health and Human Services. Vol. 78, No. 91, May 10, 2013.

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Total knee arthroplasty (TKA): volume and economics

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References:





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Improving clinical and economic value in today's ...synthes.vo.llnwd.net/o16/LLNWMB8/US...

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