Before 2007, WellMed patients who had total knee replacement procedures spent four days in the hospital and another 10 days, on average, in a skilled nursing facility before going home. Partnering with top orthopedic surgeon Dr. David Fox and officials at Northeast Baptist Hospital, WellMed helped institute aggressive in–patient and home–care rehabilitation protocols.
The result? Since 2007, most knee replacement patients at Northeast Baptist, not just WellMed patients, are on their feet and discharged to home within 4–5 days of surgery.
The effort earned WellMed the first Richard L. Doyle Award for Innovation and Leadership in Healthcare, sponsored by Milliman Care Guidelines. Given to WellMed in April 2009, the Doyle Award recognizes Milliman Care Guidelines clients who use the guidelines innovatively to advance the delivery of optimal healthcare.
“We are proud to be selected winners of the first Doyle Award,” says Dr. Terrence Nugent, vice president of Utilization Management and Medical Affairs at WellMed. “The Care Guidelines have proven to be powerful tools for us in improving patient care and outcomes. WellMed relies heavily on the Care Guidelines to deliver the best, most effective care possible to our patients.”
Dr. Nugent and WellMed Chairman and CEO Dr. George M. Rapier III first met Dr. Richard L. Doyle, founder of the Care Guidelines, in 1996. Since then, the San Antonio physician leaders have been staunch supporters of Milliman, evidence–based clinical guidelines and software used by more than 1,000 hospitals, providers and health plans to support the care of more than one in three Americans.
WellMed leaders and Dr. Fox developed a “Joint Club” approach involving: Pre–operative physical therapy; Following detailed Milliman Care Guidelines protocols in the hospital, including intensive in–patient physical therapy; Follow–up physical therapy in home or outpatient setting.
Under Dr. Fox’s supervision, Northeast Baptist dedicated a room of the orthopedic surgery wing – complete with weights, resistance bands and other equipment – so patients could begin physical rehabilitation on the day of their surgery, in most cases.
Of the 400 WellMed patients who elected for the knee replacement procedure in 2007, approximately 85 percent met ambulatory care guidelines for discharge within 4–5 days. WellMed case workers conducted home follow–up visits or patients attended outpatient rehabilitation.
At Northeast Baptist, approximately 80 percent of all patients undergoing total knee replacement procedures are discharged to home within five days. Recognizing the success of the model, Baptist Health System leaders have adapted the Joint Club model at all five of its hospitals, which saw more than 1,200 patients admitted for total knee replacement procedures in 2007.
Since WellMed patients experienced fewer post–operative complications, returned home and became ambulatory sooner and returned more quickly to normal day–to–day activities, satisfaction with the entire post–operative course has improved to an overall score of 96.3 percent in the company’s in–clinic patient satisfaction surveys. Previous surveys showed patient satisfaction at 90 percent or less at most of WelMed’s 22 San Antonio–area clinics.
Dr. Fox says those numbers mirror the results he’s seen across his practice.
“Our patients have been very happy,” says Dr. Fox, who will take over as chief of staff at Northeast Baptist Hospital this fall. “Patient satisfaction has been through the roof.”
The Joint Club model could favorably impact millions of Americans in the coming years if adopted by other healthcare facilities. According to the National Center for Health Statistics, approximately 534,000 total knee replacement procedures were performed in the United States in 2005. The rate of knee replacement for those aged 65 years and older increased 46 percent between 2000–2006, whereas the rate doubled among those aged 45–64 years during the same time period. The average age of WellMed patients is 78.
