Kristie Dennett on How Her Orthopedic Service Line Is Moving Towards Value-Based Care

#LeadingVBHC

We talked to Kristie Dennett, Orthopedic Service Line Coordinator (and CODE client) from Holland Hospital in Holland, Michigan. Holland has been collecting outcome data for a year now. Refer below to the transcription as Dennett discusses the process and hear how her hospital has benefitted.

Breanna Cunningham: Hi there. Breanna Cunningham here with Kristie Dennett from Holland Hospital where Kristie is a registered nurse and also runs their Orthopedic Service Line.

Kristie Dennett: Correct.

Cunningham: How many beds are in Holland?

Dennett: We’re about 200 beds, community hospital.

Cunningham: A community hospital that is very progressive when it comes to value-based medicine and was one of the earlier adopters of patient-reported outcomes and you’ve built a large data registry.

You’re coming up on one year of data. The first question I have for you is how were you able to drive this throughout your hospital system?

Dennett: Well certainly we’ve started into orthopedics. We have had a very active team working on a joint replacement to improve our quality and consistency with care delivery for about six years.

When we saw the success in doing that with joint replacement, we knew we needed to expand it to the rest of our ortho service line and patient-reported outcomes are part of that. We’ve had a very supportive administration, very supportive surgeons in bringing this to fruition.

Cunningham: Now the surgeons are not employed by the hospital, correct?

Dennett: We have one employed surgeon and then the others are a private practice.

Cunningham: Did you find any challenges getting those private practices in line with the hospital, or was everyone in the same boat?

Dennett: On this project, very aligned. Five or six years ago, we certainly had some challenges, but I would say that we are in just a really, really good spot now with that. We’re very collaborative in our thinking, in our strategic planning and our goals, but it’s definitely been a work in progress.

Cunningham: Okay. Now, you’ve done two different methodologies with collecting outcome data. One was an in-clinic method and then you moved the process to the outside of the clinic. Can you tell me about the differences between the two programs and what worked out for your organization?

Dennett: We weren’t really as concerned about the timeframe as we were “let’s get the data when they’re here, and have that information.” We thought we were doing okay with it, and the offices were fairly engaged in doing it and getting it to our joint replacement patients.

That is until we had to complete our application for the Blue Distinction Program with Blue Cross. One of the questions they asked on that, I guess it’s been about two years ago now, said: “what percentage of your patients do you have a pre-op patient-reported outcomes tool, and at least one post-op in that six-month window post-surgery?” We did our calculations and found out that we did a whopping 12 percent with the method we were using.

That really spoke loudly in terms of what we thought was a fairly easy process. It really wasn’t an easy process when it came down to engaging the medical assistants in the office who were the ones responsible for getting the iPads to patients.

Yes, our surgeons were engaged. They thought we were doing a good job with that. The data reports told us that we were doing really well, but it was in terms of comparing to the database, but it didn’t give us that individual patient data. It didn’t give us information on volumes, or how many people were actually filling this out. We learned from that and said, “What can we do to do a better job with this?” and started looking at what else was available.

Cunningham: Now that you have all this data, did the next method did prove successful for you?

Dennett: Correct.

Cunningham: You’ve been able to collect outcome data for almost a year now and you’re sharing that data with The Michigan State Data Registry.

Dennett: We are. Michigan has a state-wide joint replacement registry that really kicked off about five years ago, maybe six years ago now. We’ve been part of it since the beginning of 2015, but patient-reported outcomes are a relatively new addition to that registry. They started with a pilot project last summer with different hospital organizations collecting it in different manners, just to see what worked best.

They standardized the tools that they wanted to use for data collection so everybody was using the same tools, which would lend itself to the comparison. It was a small group, five hospitals started and then they added five more, and now we’ve been able to jump onto that, but in a little bit different format rather than doing it on paper on an iPad.

We’ve been able to use the data we’re collecting with CODE and do a direct file-based offload to their site, which just became available. We’re the first ones that are doing it using that method and they’re really excited to see where that goes.

Cunningham: You come to this conference, so you know there’s so much great content. What has been inspiring to you? What are you going to take home, be talking to your colleagues about?

Dennett: One of the things that really has been driven home today especially is the importance of sharing data with the team. We’ve got our core team of folks that we share data within the administration, with our surgeons, but we probably have slowed down on sharing that with a bigger audience.

For example, our anesthesiologists, we’ve got a couple of them today who are here as well, and that data hasn’t been shared with them, so they know we’re doing stuff, but they really don’t know the rest of the story and so we’ve done them a little bit of a disservice and I think we need to engage them better. That’s one thing.

The other thing that I’ve been excited about is to know that we’re all kind of struggling with the same issues and the message has been very consistent here, and some nice takeaways on where we can continue to progress in our preparation for bundled payments. We’re not part of a bundled payment structure yet, although we’re exploring a volunteer bundle with one of our commercial providers, that preparation I think is going to be a key to our success, so learning how we can continue down that vein has been helpful.

Cunningham: Well, as someone that’s been able to work closely with your organization and the providers, as well as you and your team, I imagine that maybe next year Holland will be featured and you’ll be doing a whitepaper for all the great work that you’re doing.

Dennett: Wouldn’t that be good?

Cunningham: It would be. Just keep pushing the bar. Keep doing what you’re doing and we did hear over and over just the importance of inter-disciplinary teamwork.

Dennett: Absolutely. That’s the key to success. It really is.

Cunningham: I love that you’ve … I’ve seen it directly within your organization, and then you also identified this opportunity with the anesthesiologists that are at this conference as well, and Kristie, it’s been a pleasure.

Dennett: Thank you Bre.

Cunningham: Always a pleasure talking with you.

Dennett: Thanks.

Cunningham: We’ll be back with our next interview.