Interdisciplinary teams: Where the magic happens
In April 2016, the Centers for Medicare and Medicaid Services (CMS) implemented the Comprehensive Care for Joint Replacement (CJR) model, which promotes care coordination for Medicare beneficiaries undergoing major joint replacement surgery with or without major complications or comorbidities. Quality outcomes, patient satisfaction, and cost efficiency for a defined episode of care are tenets of the CJR model. The episode of care begins with hospital admission and ends at 90 days postdischarge. It includes all related items and services paid under Medicare Parts A and B for all Medicare fee-for-service beneficiaries. Eligibility exclusions listed for Medicare beneficiaries include end-stage renal disease, enrollment in cost-based health maintenance organizations, or coverage under a United Mine Workers of America health plan.2 Stakeholders include the patient, family, surgeon, hospital, interdisciplinary team, and postacute care provider.
In anticipation of the CJR model rollout, hospital organizations were required to perform an analysis of care gaps along the orthopedic service line specific to LEJR procedures. Service line managers well equipped to analyze services during the acute inpatient stay were now challenged to critically evaluate care that extended to the postacute setting. Target goals included 1) establishing relationships with the patient and family preoperatively, 2) preoptimization to reduce risk factors and identify barriers to home discharge, 3) effective pain management critical to early mobilization, 4) defined care protocols to reduce the length of stay for both the hospital and postacute settings, 5) collaboration among the interdisciplinary team in the development of LEJR protocols, 6) strengthening handoff communication with postacute providers, 7) collaboration with postacute providers across the continuum, 8) utilization of information technology (IT) to expand patient education opportunities, 9) increased monitoring during the postacute care episode, and 10) maintaining high patient satisfaction and quality in a cost-effective manner.
Completion of this task required the support of executive leadership and a dedicated interdisciplinary team of surgeons, physicians, clinical experts, support staff, finance experts, quality and data analysts, communication professionals, case management, the IT department, and project management. The shift toward value-based care, with shared responsibility for outcomes and cost, influences the need for collaboration between physicians and hospitals.4 The effective use of teams is imperative to maximize outcomes and optimize the use of resources.5 Within the orthopedic service line, interdisciplinary teams were formed to address areas that highlighted clinical expertise and knowledge regarding standards, processes, and protocols in the context of each team member's clinical setting. Evidence supports the use of interdisciplinary healthcare teams to promote change to improve clinical outcomes.6,7
This article describes some of the changes that were made within the orthopedic service line at Jersey Shore University Medical Center, part of the Hackensack Meridian Health system.