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By Bronwyn Spira
For healthcare organizations, the pandemic highlighted the need for scalable, digital infrastructure to extend care teams’ reach to home-bound patients. Physicians who were accustomed to conducting in-person visits were suddenly reliant on telehealth appointments, which often proved inadequate for setting surgery expectations, offering remote therapy, or measuring a patient’s postoperative progress.
The lack of proactive care coordination is especially acute for outpatient facilities, which perform nearly two-thirds of all U.S. surgeries but are less likely to have traditional care management programs in place. Over the last two decades, patients have increasingly chosen high-value ambulatory surgery centers (ASCs) for routine surgical procedures, driven by cost savings and convenience. Procedures performed in ASCs cost an average of 35-60% less than ones performed in a hospital-based outpatient department (HOPD). More than half of all U.S. outpatient surgical procedures take place in ASCs, which will likely see volume growth due to an anticipated 15% increase in outpatient procedures by 2028.
The wholesale shift to outpatient settings will also be hastened by upcoming regulatory changes. In its 2021 final rule for the Outpatient Prospective Payment System (OPPS) and ASCs, the Centers for Medicaid and Medicare (CMS) announced that it will phase out the list of inpatient-only surgeries for Medicare beneficiaries over the next three years. More than 1,700 procedures once believed to be too acute for outpatient settings will now be eligible for reimbursement when conducted in HOPDs; for many such procedures, regulatory approval for ASCs is likely to follow.
While ASCs and other outpatient settings are undoubtedly more cost-effective than inpatient settings, the increase in complex procedures demands a new focus on postoperative care. ASCs, HOPDs, and other outpatient settings must strategize how they can continue to provide quality, affordable care while incorporating new care coordination capabilities. Many are adopting digital care management platforms that allow clinicians to monitor the patient’s recovery process at home.
Remote Education, Physical Therapy, and Progression Monitoring
For health systems, digital care management platforms are a key element of a postoperative strategy that helps patients avoid extraneous inpatient days and readmissions. Without a care management system, postoperative patients are more likely to be discharged to a costly skilled nursing facility or home care setting, as health systems have no other means for monitoring patient recovery.
For ASCs and other outpatient facilities, digital care management platforms also play a vital role in connecting patients and their care team in an environment with fewer built-in touchpoints. A remote care management system can serve as a valuable support system throughout a patient’s recovery process, offering targeted preoperative education, provider messaging, virtual physical therapy classes, and customized goal setting to hasten recovery. By lessening the administrative burden of routine patient education, a digital care management system allows nurse navigators to focus on patients with urgent needs, who require more intensive support.
Instead of coming in for a preoperative appointment, patients can complete virtual preoperative education from the comfort of their homes: watching videos that explain the surgical procedure, define the expected stages of recovery, and show how to prepare for recuperation. Researchers that examined virtual vs. in-person preoperative education for total joint replacement patients found no statistically significant differences in either patient satisfaction or functional outcomes as assessed by standard patient-reported outcomes measures.
After a patient’s surgery, a digital care management platform can help providers reduce the number of postoperative office visits, as it enables remote monitoring of the patient’s ongoing adherence to an evidence-based care plan. Care teams receive real-time information on patients’ progression, allowing them to determine which patients to target for follow-up phone calls and in-person appointments.
Many digital care management platforms enable direct physician/patient messaging, which can help reduce unnecessary postoperative ER visits. Patients concerned about their pain levels, medications, or swelling can reach out to their care teams for an immediate answer without needing to visit urgent care. Research shows that direct physician-patient messaging can facilitate rapid in-person treatment of wound complications while preventing unnecessary visits for wounds which appear to be normal.
By prescribing virtual physical therapy, health systems and ASCs can effectively augment or supplant outpatient physical therapy, resulting in significant cost avoidance while achieving equivalent functional outcomes. Based on the patient’s customized care path, a digital care management platform can assign sequential exercise videos to be completed within a certain time frame. Taking this one step further, an adaptive patient education program can use a patient’s participation data and solicited feedback to trigger more effective care pathways. For example, if a patient reports an exercise is too strenuous, the platform might ask questions about the patient’s pain and activity level before offering an easier set of exercises.
For the majority of patients, virtual physical therapy is just as effective as outpatient PT—and a good deal more convenient. In a retrospective review of total knee arthroplasty patients, researchers found no difference in postoperative outcomes between patients who completed web-based physical therapy versus those who completed outpatient PT.
Best of all, well-designed care management platforms can facilitate something which intermittent in-person visits cannot: the patient’s ongoing, sustained engagement in their own recovery process. By tracking their progress toward a personalized, patient-specific goal, patients are motivated to achieve each new milestone on their journey to better health.
By capturing numerous patient inputs – from usage data to the patient’s medication compliance or exercise preferences – a digital platform can drive a patient-centered, responsive care plan that serves as a continuous feedback loop between the provider and the patient. Health systems and ASCs can drive better clinical outcomes and higher patient satisfaction ratings while reducing variation, saving administrative time and expense, and eliminating barriers to care for vulnerable patients.
Bronwyn Spira is a physical therapist and the founder and CEO of Force Therapeutics.