Transforming total joint
replacement care at
Featuring Steven J. Bernstein, M.D., M.P.H.
In January of 2018, AMGA named Michigan Medicine as an honoree for the 2018 Acclaim Award. The award, sup- ported by AMGA Foundation, the association’s nonprofit arm, is designed to recognize and celebrate the successes
that medical groups and other organized systems of care
have achieved in improving the value—the quality and cost of
care—of the healthcare services they provide to their communities. It honors organizations that are meeting the IOM Aims for
Improvement and are taking the necessary steps to become
a High-Performing Health System™ as defined by the AMGA.
Michigan Medicine is one of the largest health systems in
Michigan and one of the nation’s leading academic medical
centers. The organization employs more than 2,700 physicians across 19 clinical specialties, including primary care.
It provides both inpatient and outpatient care through three
hospitals (adult, pediatric, and women’s) with 1,000 inpatient
beds, and 40 ambulatory locations with 140 clinics, specialty
centers for cancer, depression, cardiovascular care, and home
care services. In 2016, the organization had approximately
50,000 admissions, 100,000 emergency room visits, and
2.3 million ambulatory visits. The system also trains more
than 1,200 house-officers and 700 medical students.
As part of the Acclaim Award application process, the
organization was asked to highlight narratives describing
the design and deployment of major components—projects,
phases, or tactical plans—that were part of their plan to
transform the way they deliver health care in order to more
fully achieve the AMGA High-Performing Health System™
attributes, improving both the quality and cost of care. Here,
we share one of Michigan Medicine’s narratives.
Michigan Medicine participates in 18 statewide collaboratives sponsored by a major insurance company but run
independently by participating physician organizations.
One of these collaboratives focuses on joint replacement. In 2014, data showed that the group had the highest
risk-adjusted discharge rate to skilled nursing facilities
(SNF) after total hip arthroplasty across 43 physician
groups (see Figure 1). Additional data from their Medicare
Shared Saving Program ACO, which included 11 physician
organizations, showed that the group had the highest
length of stay (LOS) in SNFs after joint replacement, at
27 days. Health system leaders created a charge to reduce
the proportion of patients discharged to SNFs and to
reduce LOS in a SNF after a total joint replacement. In 2016,
Michigan Medicine performed 663 hip replacements and
396 knee replacements.
OC TOBER 2018