Alex Vaccaro Leading Rothman Institute Boldly Into the Future
Alex Vaccaro, M.D., Ph.D., president of The Rothman Institute in Philadelphia, is taking that facility into the future with strong leadership and well conceived expansions. Dr. Vaccaro told OTW, “As an organization we continue to look for strategic market/regions regarding growth for the organization. Currently we have 20 offices throughout the Philadelphia and South Jersey region and look to fill in ‘market pockets’ as well as expansion opportunities in the broader market base such as Central and Northern New Jersey.”
The Rothman Institute currently has ownership interest in nine of its office locations and is in the development phase for two further offices. In addition to ownership interest in a number of surgical facilities such as Specialty Hospitals and Ambulatory Surgery Centers, The Rothman institute owns a number of technology companies such as Business Analytics, Outcome Measurements, Telemedicine and Home Physical Therapy Applications.
“We have spent a significant amount on technology over the last seven years as we feel it will be an integral part of our success in the future of health care, ” said Vaccaro. “Our clinical outcome systems includes patient education and patient satisfaction tools and along with our Business Analytics Systems will allow us to continue to improve the quality of care, be cost effective and be the ‘Value Provider’ that the market and consumers are demanding in the future.
In addition to the technology companies, The Rothman Institute has ownership interest in Velocity Sports Performance Centers in both Cherry Hill, New Jersey and Washington Township. “This allows athletes of all levels as well as the ‘weekend warriors’ to participate in high performance training and wellness.”
“As an organization we are essentially creating a hybrid academic teaching culture with a large clinical practice base. We are following through on our commitments to a profound clinical and operational transformation that involves looking at a whole different level of effectiveness in patient care and population health. This model allows us to continue our culture of academic and teaching and integrate evidenced based medicine with our clinical practice. We feel this is the future of health care. We feel this culture, along with our outstanding physicians and staff, as well as our technology will help us not only survive, but thrive in the new world of health care.”
Orthopedics at 200 Miles Per Hour
Nascar drivers are extremely protected these days in their cars, in part because of a tragic accident 14 years ago with the death of Dale Earnhardt and in part because of the work of a physician assistant from OrthoCarolina. About eight years ago Bill Heisel noticed that help was needed in the motorsports arena. Heisel tells OTW, “Those working in the motorsports industry have to contend with the longest season in professional sports—February through November. Few people realize how taxing these jobs are on the body…and the vast majority of injuries occur amongst the pit crews.”
Heisel, who works with 19 teams including Joe Gibbs Racing, Stewart-Haas Racing and Hendrick Motorsports, states, “I have been enamored with the seriousness with which NASCAR takes safety. Since the 2001 death of Dale Earnhardt things have greatly improved, with softer walls called Safer Barriers, advances in the car construction and design engineering, and the overall goal of making the driver part of the vehicle rather than passenger. Drivers are essentially cocooned in the cars. There are improved crumple zones in car that allow energy to be dispersed around—rather than through—the driver. There have been major advancements in safety seat design and seat material. Truly, we went from drivers making their own seats to the use of carbon fiber technology that is custom molded to fit the driver perfectly (the way a custom knee brace is made for an NFL player). This has given us an improved ability to strap the driver into the seat with more sophisticated belt technology that keeps him or her from going forward or submarining’ (scooting out the bottom of the seat).”
“For the drivers, the biggest medical issue they usually have to contend with is related to being in a 150 degree plus car for four hours (on a 100 degree day). To handle that—as well as the G-forces—drivers have to be at a whole different level of fitness. They are true athletes and train like true athletes with conditioning and weight training exercises. In a hit that occurs at the corners you’re talking about more than 70G due to the deceleration forces. If you’re taking a 200 mph turn at Daytona and you pull to an immediate stop, then that’s when the G-forces get enormous.”
“My biggest fear is that the guys on a pit crew will be hit by cars…it happens every season in minor impact events. At every pit stop there is the potential for long bone trauma as a result of a car skidding in or brakes failing. With a 3, 400lb car zooming into the pit area, we always worry that a crewmember might get pinned against the concrete wall in the event of a mechanical parts failure or miscalculation in speed and distance by the driver.”
“The days of pit guys working without helmets and fire suits are long gone; now, pit crews train as athletes too. The workouts are heavy lifting and conditioning as well as live pit stops in practice three days a week during the season…and it’s fast. A pit stop of 12 seconds or less is considered to be very good; an outstanding pit stop is in the high 9s or 10s for 4 tires and fuel. We see a lot of upper extremity injuries amongst the tire changers. They get tendonitis in elbows and knees, wrist and hand injuries from pulling tires or getting a hand stuck between the sheet metal and inside the tire well. There are injuries from the vibration and torque forces coming off the nitrogen powered air guns. The jackmen injure their shoulders, backs, elbows and more. They get injuries including, tendon ruptures (rotator cuff, biceps, triceps and quad and patella tendon), and herniated lumbar discs because their role is to pick up each side of the car with a lightweight jack in addition to being fast around the car during stops and stepping off a 4 foot high concrete retaining wall. The tire carriers carry tires from the pit wall to the car and then bring the old tires back. They are carrying these 70lb tires with the rims and inner liners…and stepping off a 4 foot high pit wall—so the risk to knees and shoulders is evident.”
“I have been a physician assistant for 25 years, and I’m thrilled to have been a part of the evolution of care for this niche in orthopedics. It has been a rewarding experience to have taken sports medicine principles and modified them in order to treat people who participate in motorsports.”
Harvard and Hoag Orthopedics Team up to Rethink Healthcare Delivery
Hoag Orthopedic Institute (HOI), which only opened in 2010, was recently approached by Harvard due to its rapid, efficient growth and its successful model. Dereesa Reid, CEO of Hoag, tells OTW, “In 2006, The CEO and Board Chairman of Hoag Memorial Hospital Presbyterian along with Dr. James Caillouette, Orthopedic Surgeon read the now-famous book by Michael Porter and Elizabeth Teisberg, Redefining Healthcare. The board of Hoag embraced the philosophy that we needed new models of care in order to drive value. Hoag Orthopedic Institute a newly formed entity was a startup and we didn’t have any metrics. So we created them and collected the appropriate data. From the beginning we had a commitment to driving value in our hospital and two surgery centers. Early on, we began by making our data transparent internally with physicians and employees then in 2013 we began publishing our data in our annual Hoag Orthopedic Institute Outcomes Book.”
“One of the things that has helped us produce outstanding clinical outcomes is that we are able to empower doctors involving them in leadership positions as well as day to day shared decision making with our clinical teams. We know that traditional hospital service lines have some degree of success, but they cut across legacy chains of command lack clear lines of authority and organizational alignment. When you can step off to the side and only do orthopedics, then that is exceptionally efficient and clinically focused around providing the best care possible for orthopedic patients. When we collect data it is not comingled with data that you would normally find in an acute care hospital. When we show the data to our doctors and staff, it is clear that it’s only orthopedic data. This makes it much more likely for people to actually believe the data. When I discussed data with Robert Gorab, M.D., the Chief Medical Officer at HOI, he noted, ‘Data drives behavior. We will look at the clinical data and see how people are using supplies and then show this information to the doctors…and that will drive behavior.’ And it did. No one wants to be an outlier, so once people know that the data is reliable they adjust their practice patterns move toward best practices.”
“One of the projects we are working on with Harvard is the International Consortium for Health Outcomes Measurement, a nonprofit started by Michael Porter. The meetings, which attract 400-500 people from all over the world, have the agenda of defining international standards for patient reported outcomes. Each year is different medical conditions are studied; now we are participating in the ICHOM osteoarthritis group.”
“Last year, we also participate in the Institute for Healthcare Improvement’s Joint Replacement Learning Community, led by Harvard’s Dr. Robert S. Kaplan and Derek Haas where Harvard professors have the opportunity to teach to laypeople. There were over 32 orthopedic groups spanning the U.S. and several international countries. Our multidisciplinary team consisted of cost accountants, clinical quality nurses, performance improvement experts, etc. It wasn’t just an opportunity to learn from the professors, but it was a chance for the orthopedic groups to share best practices.”
“Afterwards, I was approached by Dr. Robert Kaplan, who said, ‘You are doing exceptional work and we want to do a case study.’ So he, along with Jonathan Warsh (also from Harvard) travelled to Orange County to visit HOI. They spent hours interviewing leaders, physicians and staff. . It was such an honor to work with Dr. Robert Kaplan, who wrote THE book on balanced scorecards, he was impressed with how we were reporting and making our data actionable throughout our organization.”
“An example of one of our protocols was the preoperative screening and screening for MRSA (methicillin-resistant staphylococcus aureus). We were not merely approaching a potential MRSA problem a couple of days before the surgery, but far in advance. Another unusual aspect of Hoag Orthopedic Institute is that our orthopedic surgeons decided to empower their anesthesia colleagues to study and determine the best pain protocol. This was a very unusual, collegial, and productive decision and is just one example of how our orthopedic surgeons engage and empower our anesthesiologists.”
“And recently, our spine doctors began evaluating products based the value equation. In other words, analyzing product offerings bases on achieving the best outcomes at the lowest cost then as a group pro-actively reached out to the nurses, saying, ‘Here is the product we selected and we want to work with you so that you know exactly how to use it.’ I’ve never that seen that in orthopedics and especially not in spine. I must say that when an administration sees doctors stepping up like that they should recognize them.”
