Morristown Nursing Team Presents New Model for Hip/Knee Patients

Members of Atlantic Health System’s Orthopedic Nurse Navigation team presented results from the implementation of a comprehensive standardization and risk stratification system that improved outcomes for patients receiving total hip and knee replacement at Atlantic Health System hospitals at the National Association of Orthopedic Nurses Congress 2019, held in Atlanta, Georgia.

As a result of the new system, Atlantic Health System experienced a 117 percent increase in patients discharged directly to their homes, a 52 percent reduction in the use of skilled nursing facilities, an average reduction of 6.7 days in acute-care facilities, and nearly $4,000 in cost savings per patient.

“By changing the way we approached care coordination for our hip and knee replacement patients, we were able to send more patients to recover more comfortably at home, better engage our physicians, and realize significant cost savings for both the patient and hospital system,” said James Wittig, MD, Chairman, Orthopedic Surgery, Morristown Medical Center, and Medical Director, Orthopedic Surgery, Orthopedic Oncology and Sarcoma Surgery, Atlantic Health System. “We are constantly looking for new ways to transform the way we approach health care, and this multidisciplinary team effort is a strong example.”

The model came about in response to Medicare’s mandatory Comprehensive Care for Joint Replacement model. The payment model, scheduled to run through 2020, shifts accountability to hospitals. Each hospital receives a composite quality score based on factors such as complication rates for joint surgery and patient satisfaction rates. Hospitals with higher scores receive higher reimbursement rates from Medicare.

The model was implemented in four of Atlantic Health System’s hospitals: Morristown Medical Center, Overlook Medical Center, Chilton Medical Center and Newton Medical Center. The goals of the plan were to increase the rate of patients discharged to their homes instead of post-acute care facilities and to reduce the length of stays at post-acute care facilities. A steering committee worked on standardizing order sets, care guidelines and patient and surgeon education throughout Atlantic Health System, and more attention was focused on patients’ needs and creating a safety net of medical professionals and family members to guide patients through recovery.

The team implemented the Risk Assessment and Prediction Tool (RAPT) to make sure that patients deemed able to go home had adequate support and resources to help them recuperate, including “Navigators,” nurses who were responsible for communicating with patients before, during and throughout their recoveries.

“When patients and their loved ones are able to better understand and navigate the sometimes complex health care process, they are more likely to have better outcomes and focus wholly on their recovery,” said Mina LeFevre, MS RN ONC, Program Manager, CJR, Atlantic Health System.

The effort to improve the patient experience paid off: Morristown Medical Center earned the second highest reimbursement in the country for its year one performance in the new Medicare model.

About Orthopedics at Atlantic Health System

Atlantic Health System’s Orthopedic program offers residents of New Jersey and the surrounding areas access to high-quality multidisciplinary treatments that span pre-surgical education through post-operative rehabilitation. With the latest diagnostic technologies and robotic equipment, many of our board-certified surgeons are experts in minimally invasive techniques that result in faster recoveries, greater range of motion, and smaller scars.

Each year, the Atlantic Orthopedic Institute performs more than 4,000 joint replacements and treats more than 1,400 traumatic orthopedic injuries, and US News and World Report recognized Morristown Medical Center as a high-performing hospital for orthopedics in 2018.

Orthopedists at Morristown Medical Center provide assistance caring for patients with complex fractures of the pelvis and upper and lower extremities. For complex sports injuries, Atlantic Sports Health has highly-trained physicians who are experts at diagnosing and treating orthopedic and sports medicine problems and are active participants in academic and research programs. The Orthopedic Oncology program performs limb-sparing surgeries for patients with bone tumors or sarcomas.

For children with orthopaedic needs, orthopedists collaborate with pediatricians from Goryeb Children’s Hospital in all aspects of care, including state-of-the-art diagnostics, surgical treatment and assistive technology.

Atlantic Health System Orthopedics is nationally recognized for its expertise, earning numerous awards and accreditations for its services. Learn more: https://www.atlantichealth.org/conditions-treatments/orthopedics.html.