Interdisciplinary Value-Based Care Q&A with Senior Clinical Director Miki Patterson: Part 2 of Our Special Series Featuring Strategies for Improving Orthopedic Patient Outcomes

Author: Kathryne Auerback


The way we deliver care across the episode is changing, driven by the pursuit of a patient-centric model – an undertaking that can only be achieved by breaking down the silos of a fragmented health system.

The upcoming ACPM Interdisciplinary Conference on Orthopaedic Value-based Care provides a game-changing opportunity for surgeons, anaesthesiologists, nurses, and healthcare administrators to join forces in uncovering cutting edge industry trends and insights.

In Part 2 of our special series, we spoke with conference speaker, Miki Patterson, PhD, AP, Senior Clinical Director at OptilignHealth, about her best practices for value-based care.

Can we talk about your background and your role as senior clinical director? How has the shift to value-based care influenced the work that you do?

I was a nurse practitioner in orthopedics at a Level 1 trauma center for 25 years, and I have been doing hospital consulting for about eight years now. The company I worked for originally, which has since vanished, helped hospitals that were trying to bundle payments for total joint. That’s where it started. We helped them go from fee-based to value-based care by looking at what their outcomes were, streamlining the process, and getting it patient-centered.

When I worked as a nurse practitioner, it was in a time where you’d order x-rays, order CTs—it didn’t matter—whatever you ordered, someone was going to pay for it. What has happened with value-based care is that people are going from being volume-focused to becoming a center of excellence. Hospitals want the patient satisfaction; they want to lure the patients in. And they’re also trying to increase their margins or decrease their losses. This value-based care has now impacted the hospital’s bottom line, because if they’re bundled, they’re not going to make any more money. So anybody that doesn’t get on board with utilizing best practices – they’re wasting money with things that are no longer best practice.

Why is it important for healthcare executives to have the opportunity to connect and collaborate with nurses, anesthesiologists and surgeons when it comes to improving the models of care?

Last year when I went to this conference, I was blown away because they purposely sat nurses and surgeons and administrators and anesthesiologists together at the same tables. You didn’t just sit with your friends and talk the same talk. And when we got to network, there were so many things that had to do with patient care satisfaction that the administrators did not necessarily know. There were things the surgeons didn’t know about cost and margins. And there were things anesthesia brought to the table about pain management that would decrease length of stays that some of the nurses didn’t know.

Getting everybody together to start talking about what we think of from our perspective helps people with other perspectives see the big picture. It gives people new ideas they can bring back to their practice, to their hospital, or to their group.

Can you share a brief description of your conference topic, “Setting Up a Virtual Clinic”? Why is this topic important to you, personally?

This is how value-based care has been pushing the envelope to do better care and do it more efficiently, and get people out of the hospital. We know people that stay in hospital can get infected or have other problems. So the healthier the person is coming in, and the more communication they have, the more part of the process they feel.

The next step is virtual clinics. Technology has now caught up, so much so that we’re even able to get a consult form from a primary care doc copied and pasted and sent to an orthopedic clinic. Someone chooses to see the patient on the date the patient chooses, and now we’ve got all of the information right here. There’s no calling back and forth, no changing appointments. Now that patient, with all their information, is being seen. That’s already a big efficiency improvement. But that patient will also start looking at their network of who’s taking care of them, and the docs, anaesthesia and primary care staff can all look at the health of this patient, and everything will be in one place.

The other big part of this is, typically you would have to come back to clinic to have the wound looked at and find out how you’re doing. Now, the patient can just show their wound through the technology, and talk about it to the healthcare professional at the other end. Some of the phone calls that used to be made by a navigator can be done through email or text. And if there’s a problem, they can come face-to-face. It’s really exciting that we’ve come so far, and now there are platforms out there that can talk to any EMR.

How do big data and virtual clinics impact the patient’s experience across the episode of care? Why are they so valuable from a patient perspective?

From a patient perspective, you have instant access to your clinician. As opposed to calling the doctor’s office, telling them you need to talk to the nurse and then the nurse talks to you and they find a doctor, there will be a navigator or some clinical expert that’s already talking to you, almost instantly.

I think it helps a lot with anxiety around travelling and parking. If you want to go to a hospital in Boston, you can drive 45 minutes on the highway and take an hour and a half just getting through all the roads and finding a place to park for $30. Then you have to walk up a long distance to get to your orthopedics appointment, which can cause a lot of stress on someone with a brand new joint or a fracture.

Yes, you’re going to have to come in and get x-rays, but maybe you’ll be able to get your x-rays at your local hospital and send them to the surgeon. There are a lot of things that could happen. There are also patient portals where you can talk to other patients who have the same things going on. So I think there are a lot of things that are going to be positive for patients.

How does this decrease risks and lower cost for everyone involved?

There are a lot of frustrating issues in the system that decrease the ability of the doctor to know all the things they need to know when that patient comes in the door. When you have a virtual clinic, the primary care doctor has immediate access to the patient’s medical history. Now, they already know this person lives alone and has diabetes. There’s a lot more information, which makes their care safer.

And once they’re in the system, all of the people caring for that patient in the system have access to all of the important info. If Mrs. Smith calls you up on the phone and says, “My knee hurts,” you instantly can go to her on your virtual clinic and find out her history, when her surgery was set, who her doctor was, what her vital signs were, when the follow up is, etc.

We know there are a lot of mistakes happening in hospitals, and hospitals are being pushed beyond their limits. They are trying to take care of too many things in a rushed manner. Every hospital is all about discharge. In this methodology, when you have a virtual clinic, the patient may come into the hospital, but they’re already set up with the communication, they already understand this whole system, so they can go back to their own environment, but still have access to the support they need.

Can you share any patient testimonials that demonstrate this?

One of the patients got a text from his doc the night before the surgery and the doc just texted him, “We’ve got this, don’t worry.” And the patient came in the next day and said, “I feel really confident; my doc texted me saying, we’ve got this.” That little piece of communication has the ability to make the patient feel so much better.

What does the future of value-based care look like to you? What’s next?

I think the future of medicine is going to be value-based care, and what I’m seeing happening is people are now really starting to participate in getting a patient-reported outcome.

This helps us improve our practice because we see that all these patients with “XYZ” had longer lengths of stay, or their pain wasn’t managed as well. One of the things I do when I look at data is look at who is doing well, and find out what they are doing to have that outcome.

And for my administrators in the room, these virtual clinics will be able to tell you how much of the healthcare dollar is being spent in all these places. You can tell if someone went over a bundle when they’re going over the bundle. You can categorize if one particular surgeon is always going over the bundle, and maybe that’s an opportunity to present the data and have a conversation.

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The American College of Perioperative Medicine hosts the Interdisciplinary Conference on Orthopedic Value-Based Care, February 9-11, 2018, in Newport Beach, CA. An immersion weekend that covers the operational, financial and clinical aspects of orthopedics practice, the conference is an opportunity to learn more about the Perioperative Surgical Home – Enhanced Recovery model.

OrthoServiceLine.com is pleased to sponsor this event. Enter OSLTRANSCEND at registration to claim your 10% subscriber discount.


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