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An innovative program created by CEP America, one of the nation’s largest providers of multi-specialty acute care solutions, integrates anesthesiologists more fully into care plans for hip fracture patients and is reducing dependence on opioids, lowering Length of Stay (LOS) and reducing hospital costs. Additionally, it is helping to provide optimal care to medically fragile patients.
CEP America’s Hip Fracture Pathway program, first undertaken at a 432-bed hospital in Northern California, is producing strong results, reducing LOS by 25 percent and saving the hospital more than $3 thousand per case. The program emphasizes the role of anesthesiologists in managing pain and controlling the use of opioids.
The Hip Fracture Pathway was developed to help hospitals meet the challenges of Medicare’s bundled payment system for hip fracture surgeries, which goes into effect in July. The intent of Medicare’s program is to hold hospital’s accountable for the quality and cost of care provided, from admission through 90 days post discharge. Hospitals will receive a higher reimbursement for those cases that are within the new guidelines. If performance is under guidelines, hospitals will have to repay Medicare for a portion of the cost.
One of the first steps CEP clinicians and hospital leadership took was to establish clinical ownership of all hip fracture patients. When a hip fracture presents to the ED, the attending physician alerts the on-call anesthesiologist who assumes responsibility for care coordination. The anesthesiologist first consults with an orthopedic surgeon to determine appropriate pain management. When indicated, the anesthesiologist then heads to the ED to administer a femoral or fascia iliaca nerve block. The procedure provides relief while reducing the need for opioid medications.
“Finding ways to better integrate the acute care team continues to challenge hospitals,” said Harrison Chow, MD, Anesthesia Project Coordinator with CEP. “One of the best outcomes of this program is that departments involved have left their silos and merged into one cohesive team. This is a great program for the entire care team and most importantly, for our patients."
To expedite acceptance and awareness of the program, CEP’s hospital partner sponsored a regional anesthesia workshop for the ED and anesthesia teams. In addition to cost savings, the length of time a patient is in the hospital has gone from 133 to 96 hours, patient satisfaction is improving, and use of potentially over-sedating opiates is down. Most importantly there has been an organizational culture shift that highlights the need to further investigate and invest in new approaches to pain management.
Anecdotal reports show that patient satisfaction is also increasing. Chow notes that hip fractures tend to bring families to the hospital. “Patients and their families appreciate seeing a fully collaborating team that communicates well and is focused on the recovery and comfort of their loved ones,” he says. “This program is helping us to hit on the things that matter to patients, to us as physicians and colleagues and to hospital leaders.”
For more information, on CEP America’s Hip Fracture Pathway program, please see this case study.
About CEP America
CEP America is an independent physician‐owned partnership, focused on delivering exceptional care for patients across the acute care continuum. Since its founding in 1975, CEP America has expanded nationally, delivering integrated services that span urgent, emergent, inpatient, post-acute, and peri-operative settings. Today, CEP America includes over 3,150 providers treating 6.3 million patients a year at 250 practices. Visit www.cepamerica.com. Follow CEP America on Twitter at twitter.com/CEP_America.
Scott Public Relations
Brenna Harrington, 770-338-0357
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