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Thursday, March 1, 2001

Surgical team approach improves profitability

In 1995, the Illinois Bone and Joint Institute in the Chicago suburb of Des Plaines, Ill., implemented a surgical team approach utilizing a select group of first assistants, scrub and circulating nurses for every primary total knee and total hip arthroplasty procedure.

The surgical team approach was able to improve profitability margins in total hip and knee arthroplasties done in the last decade, despite the 1997 Balanced Budget Amendment, which threatened these margins in total joint replacement. But they warn that further cuts in reimbursements to hospitals may compromise the quality of patient care in the future.

The coauthors of scientific paper 4 said Wednesday data for this study from 1988 and including 1996 on 1,755 patients was provided by Lutheran General Hospital in Park Ridge, Ill. from the Medicare UB-92 form. Information for 1997 and 1998 was obtained directly through the Center for Health Care Industry Performance Studies, compiled from the clinical assessment profile.

The results demonstrate that since 1995, with a consistent surgical team, profit margins have increased by greater than 100 percent, while cost, DRG reimbursement, and implant price has varied by less than 5 percent in almost all instances. Prior to this, their strategy was using care paths, decreasing length of stay and competitive implant pricing.

Despite their efforts, they say further decline in reimbursement to hospitals will continue to erode what is left of profit margins, and may result in reduction of quality patient care. Lower quality implants may be chosen for, or forced upon surgeons and patients to reduce costs. Reduced payment to nursing staff may also occur and may potentially destroy the surgical team approach, which was their last strategy in cost effective quality care.

Coauthors of the study are Wayne M. Goldstein, MD; Robin Wall, PA-C; and Jill Branson, BSN, all of the Illinois Bone and Joint Institute, Des Plaines, Ill.; and Rima M. Nasser, MD, Chicago, Ill.

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Last modified 20/February/2001 by IS