Hospitals Must Rethink How They Deliver Orthopedic Care to Meet New Joint Replacement Requirements

Posted by Deirdre Wilson on Oct 18, 2018 7:12:00 AM
Deirdre Wilson
Find me on:

The Joint Commission this year announced a major change for hospitals and health systems seeking advanced, disease-specific, Total Hip and Total Knee Replacement Certification. Hospitals now need to comply with additional performance measures to try to address the top clinical concerns in healthcare today.

The new measures are associated with fewer post-op complications, readmissions and deaths and lower cost – emphasizing how critical it is for healthcare to move the needle in these areas. In addition to focusing on clinical metrics, the Joint Commission is emphasizing the need for patient-reported feedback – once again acknowledging that patients are key partners in reducing healthcare costs. 

Lowering cost, improving post-surgical outcomes and driving patient-reported feedback are lofty goals for the Joint Commission to set for hospitals. But these goals are achievable if hospitals expand how they deliver orthopedic care to include reaching patients outside hospital walls.

Many hospitals have yet to implement technology to connect with patients beyond face-to-face visits. For those hospitals, achieving advanced certification will be especially challenging. Patient engagement solutions that communicate digitally with patients between appointments, both pre-op and post-op, are essential to impacting post-surgical outcomes because these technologies can reinforce care instructions, improve patient recall and set expectations for surgery and recovery.

See how HealthEast uses patient engagement technology to improve post-op  outcomes  for joint replacement.

These solutions also offer innovative ways to collect patient-reported outcomes and feedback, rather than traditional paper surveys, and comprehensive analytics to monitor patients’ progress through discharge and recovery.

Case Study: Improving Joint Replacement Outcomes With Digital Engagement

Take HealthEast, a mid-size health system that improved orthopedic outcomes by rethinking how it delivers orthopedic care.

Through digital engagement outside the hospital, HealthEast is able to send more patients home safely after surgery, decreasing discharge to a skilled nursing facility 36%, reducing readmissions by 18% and ED visits by 36%.

They’ve also improved care team efficiency, decreasing day of surgery cancellation by 48% and shortening length of stay by .11 days or 4.6%.

The Four New Performance Measures

The four performance measures the Joint Commission added this year each require demonstrated improvements by hospitals seeking advanced certification for total joint replacement: 

Measure #1: Increased rate of the use of regional anesthesia 

Why? Regional anesthesia is associated with fewer post-op complications and deaths than general anesthesia.

Measure #2: Increased rate of ambulation post-op on the day of surgery

Why? Getting up and moving the same day as surgery takes place aids recovery and is associated with fewer post-op complications.

Measure #3: Increased rate of discharge to home 

Why? Discharge to home costs less than half ($8,300 vs. $16,900) compared to discharge to a skilled nursing facility. And researchers have found that discharge to home results in no difference in pain, functional outcomes or patient satisfaction from being discharged to a skilled nursing facility (SNF).

Measure #4: Increased number of patients completing pre-op functional / health status assessments 

Why? Also known as patient reported outcomes – such as the PROMIS Global, HOOS Jr. and KOOS Jr. – these are standard surveys given to patients 90 days before and after surgery to assess improvements in their condition (and satisfaction).

The Joint Commission wants to see more patients completing the pre-op assessments to better inform surgeons about patient health before surgery and to provide a baseline for these surveys after surgery.


At their core, the additional performance measures ask healthcare providers to better prepare patients and set expectations for joint replacement that will help drive shorter hospital stays, discharge to home and data that monitors patients’ knowledge, skills, confidence and satisfaction with their surgery. That requires a patient-provider connection outside the hospital.

Whether or not hospitals have that kind of remote access to orthopedic patients will set them apart and put them on the fast track to achieving advanced certification.

HealthEast improves orthopedic outcomes

Topics: Episode of Care, Improving Patient Outcomes, Patient Engagement, Innovation, Patient Experience