A quickly growing skilled nursing provider has launched a new orthopedic recovery program designed to align with two separate federal policy initiatives: addressing social inequities that might slow patient recoveries and streamlining care to help reduce overall healthcare costs.
Marquis Health Consulting Services’ OrthoWIN, launched this week, provides more specific and targeted care plans for patients who won’t have adequate support at home immediately following hospital discharge.
Nationally, more patients have been referred to home care following joint and orthopedic surgeries in recent years. But federal data now being collected on social determinants of health — and anecdotal accounts — reveal that some patients still need skilled care because of, for instance, space limitations that might keep them from doing therapy at home or transportation issues that limit their access to follow-up care.
OrthoWIN, now live in 23 facilities in Marquis’ mid-Atlantic footprint, also is designed to appeal to acute care partners who are seeking to reduce spending — and potentially lower rehospitalizations — on episodes of care related to joint replacement or fracture care.
“Many of our hospital partners nationwide are participating in bundled payment programs and in other forms of innovation,” Jennifer Hertzog, vice president of marketing and business development for Marquis’ Mid-Atlantic region, told McKnight’s Long-Term Care News on Thursday. “This program 100% aligns with innovation and cost-of-care goals. The goal is to deliver the highest quality of care in the shortest period of time and prepare the patient for the next, optimal step-down in their continuum.”
Pain, therapy addressed
OrthoWIN uses an integrated treatment plan that includes pain management and physical therapy. Coordination between the patient’s surgeon and the care team begins immediately, and Hertzog said the goal is to have a “warm handoff” from surgeon to rehabilitation providers.
The program is directed by a Physical Medicine and Rehabilitation (PM&R) specialist with the support of an interdisciplinary care team. The PM&R plan is a guided document directing therapy up to seven days a week, and offers a “whole body” approach to manage co-morbidities such as cardiac and pulmonary care, chronic kidney disease management, and memory care.
Patients who do not have adequate home support are identified by hospital-based case managers and care navigators, which helps the OrthoWIN team prepare for a person’s specific needs.
Tricia Heller, director of specialized programming, told McKnight’s that, through the program, care teams can conduct virtual tours of patients’ homes to determine what barriers to success might exist once they leave the sub-acute care rehabilitation facility. Providers will look at whether a patient can or will be able to drive as well as other social determinants of health.
“We have physician-led programming,” Heller said, adding that care plans are developed to maximize the time patients are expected to be in residence at a facility. “We want to minimize the need for them to return to outpatient appointments and make the time with us more beneficial.”
