The Revolution of HOPCo – Standardization, Better Care, Lower Cost

The Surgeon’s Perspective

“About 90 percent of the time, most patients fall into certain categories and can be treated in a similar fashion,” said Dr. Ali Araghi, director of CORE’s spinal division. “What we’ve done differently is we’ve had clinicians sit around the table and make the decision on what is the best way to treat something. The patient’s best interests are held in mind by physicians that are practicing surgery daily and understand the workflow better than anyone else.”

Adopting implant and equipment standardization is just as critically important. For instance, typically, a scrub tech for multiple surgeons must learn how to handle and sterilize many kinds of equipment, some of which must be taken apart for the sterilization process and put back together. But under standardization, these procedures become smoother and more efficient.

“The scrub techs that operate with us understands the system much better because they are getting more exposure to it on a daily basis,” said Araghi. “Our sterilization department is now sterilizing just one set of equipment [for a particular surgery] that they are very familiar with and they have half the inventory to learn overall. This reduces cost.”

Standardization??!!!

“Standardization also allows us to see when things may or may not be helpful for the patient, seeing right away when the right care may be going astray,” said Slate. “We’ve done significant research to make the best decision that a piece of equipment or an implant is the right thing to standardize to.”

But standardization is not 100% set in stone; a single company can’t provide everything they need and sometimes a patient may need an implant that isn’t standardized. The goal is to hover around 90% utilization. As a result, there is no penalty for a surgeon that averages, say, 85 % utilization.

“If you’re doing 30 surgeries a month and you decide 29 of them need to use instruments from a different company, that is problem,” said Araghi. “But if you use different implants for 7 of those cases, that’s totally fine, that’s what the patient needed.”

The evolution of technology is also considered. If a new instrument comes on the scene and provides better outcomes than what they currently use, Araghi says they will change standardization to that company. And a company not staying current with changing technology would also be a cause to consider switching to a new company.

“It’s a fluid system that can be changed, but we all want to be flowing down the same river. If we change rivers, we do it as a team,” said Araghi.

Interventions? Less Is More

Cutting down on unnecessary interventions is another area where patient care is improved and cost is abated. If a patient comes into the office with two weeks of radiculopathy (pain, numbness or tingling), and asks for an MRI, most physicians might order it. At CORE, if the patient doesn’t present with any neurological deficits, they hold off on an MRI.

“I spend extra time explaining to my patient that most of these things actually resolve on their own with anti-inflammatory medications or physical therapy,” said Araghi. “Our protocols state that this approach is better patient care because we’re not exposing the patient to a possibly unnecessary MRI and the insurance company saves money.”

As with any process, there is always room for improvement. For Araghi, one area he wants to see gains in is the way he and his colleagues choose protocols. Now, decisions are based more on consensus evidence, rather than true evidence from level 1 studies.

“I would love to see more comparative level 1 studies that would clearly say, for example, with spondylolisthesis, a posterior fusion is better than anterior fusion, or vice versa,” said Araghi. “We don’t have that data yet. So that’s something that needs to be refined, but it’s going to take a lot of academic work.”