An Assessment of the Safety of an Orthopedic Specialty Hospital: A 5-Year Experience

Abstract

One of the goals of orthopedic specialty hospitals is to provide safe and efficient care to medically optimized patients. The authors' orthopedic specialty hospital is a physician-owned, 24-bed facility that accommodates a multispecialty orthopedic practice in the areas of spine, hip and knee arthroplasty, shoulder and elbow, sports, foot and ankle, and hand surgery. The purpose of this study was to examine the first 5 years of an institutional experience with an orthopedic specialty hospital and to determine if any procedures were at increased risk of postoperative transfer. When higher-level emergency treatment was required, patients were appropriately and expeditiously transferred and treated at an acute care facility. Length of stay compared favorably with that in traditional acute care hospitals. The specialty hospital may be an appropriate model for delivery of care to medically screened patients in the United States. [Orthopedics. 2017; 40(4):223-229.].

Reimbursement of Lumbar Fusion at an Orthopaedic Specialty Hospital Versus Tertiary Referral Center

“…Patients who undergo surgery at an OSH are usually younger with lower comorbidity burdens due to risk stratification protocols undertaken before surgical scheduling. 7,9,17 Although "cherry picking" young, healthy patients is a common criticism of OSHs, our study attempts to minimize this bias by matching for several variables including age, CCI, and type of procedure performed. Because the OSH has fewer critical care resources, there is a low threshold to transfer unstable patients to the TRC if a complication develops.…”

“…The results suggest that lumbar fusion performed at an OSH reduces Medicare reimbursement (i.e., results in cost savings per episode of care), largely due to lower post-acute care costs. Patients who undergo surgery at an OSH are usually younger with lower comorbidity burdens due to risk stratification protocols undertaken before surgical scheduling 7,9,17 . Although “cherry picking” young, healthy patients is a common criticism of OSHs, our study attempts to minimize this bias by matching for several variables including age, CCI, and type of procedure performed.…”

“…5 Multiple surgical specialties have demonstrated the clinical and financial value of performing surgery at specialty-specific hospitals. [6][7][8][9][10][11] Tertiary referral centers (TRCs) have high overhead costs, which are ultimately passed on to payors and patients. 12 Lumbar spine procedures performed at OSHs are more efficient, with less anesthesia preparation time and conclusion time (i.e., skin closure to patient out of room).…”

“…Multiple surgical specialties have demonstrated the clinical and financial value of performing surgery at specialty-specific hospitals 6–11 . Tertiary referral centers (TRCs) have high overhead costs, which are ultimately passed on to payors and patients 12 .…”