Orthopedics & Sports Medicine Outcomes Report
This report represents the ongoing efforts of our dedicated caregivers to deliver the highest quality orthopedic care. It describes many of the services available to our patients, our commonly performed procedures and reviews our latest results. When possible, we compare our results with published regional and national benchmarks. We feel this transparency will help both referring physicians and patients make informed decisions regarding their orthopedic care.
At Maine Medical Partners, a part of the MaineHealth system, everyone is committed to providing the best possible care for our patients. We are happy to compare our results with other organizations. Our surgeons, advanced care providers, nurses, and staff are all committed to giving our patients the highest quality care and restoring function to the maximum achievable level.
Even with the challenges we have faced this year with COVID-19 including the postponement of elective surgeries, we were able to adapt quickly, making it a safe environment for our patients and health care providers and are moving forward even stronger. We are proud of the results contained here and they reaffirm the success of our program and the high quality of care given to our patients by our orthopedic care teams.
ORTHOPEDICS & SPORTS MEDICINE SURGICAL VOLUME
We are very fortunate these days to have unbiased, evidence-based, health care metrics that are relevant to decision making for patients and their families. Hospital Compare is part of the Centers for Medicare and Medicaid Services (CMS) Hospital Quality Initiative. All hospitals in the United States that take care of Medicare and Medicaid patients are included in this analysis (over 4000 Medicare-certified hospitals and over 130 Veterans Administration medical centers). CMS looks at three very important aspects of hip and knee replacement surgery:
- Complication rate: serious problems like infection, heart attack, pneumonia, sepsis, pulmonary embolism, bleeding, dislocation, fracture and death
- Readmissions: an unexpected return to the emergency room or hospital after a patient has been discharged from their hip or knee replacement
- Hospital payments: the cost of care to the system (and therefore, the patient) is captured in this metric
The Highest Honors in all Three Categories
Of the 2,786 hospitals evaluated for complications, only 64 (or 2.3%) met the benchmark for statistically better. MMC was included in that group. For readmissions, 2,798 hospitals were considered in the USA. Only 44 (or 1.6%) met the cut-off for statistically better. MMC was again among the very best.
Finally, CMS identified MMC as one of the few hospitals with the very highest value (lower charges for care) in joint replacement surgery. It is rare for a hospital to be recognized as “better” in any one of these categories, let alone all three. We are so proud that the MMC Joint Replacement Program has been identified as such a program.
In all of the New England states, only two programs were as good as MMC in both measures of patient outcomes: the Hospital for Special Surgery in New York City and the New England Baptist hospital in Boston. Neither of these hospital programs were recognized for keeping costs low; so that makes MMC the best value available: excellent outcomes at a fair price.
In January of 2020, CMS recognized our hip and knee replacement outcomes as achieving the prestigious goal of being in all three categories. This honor is meaningful in that it validates our training, hard work, and unwavering attention to evidence-based medicine. For our patients, it allows them to know that surgery with one of our surgeons offers the highest chance of achieving the objectives of pain relief and return to full function, with the lowest risk of complications or readmissions. We are grateful to our entire team for making this amazing opportunity available here in Maine.
Health care writer and editor Jacqueline LaPointe reports that according to the most recent 100 Top Hospital study from IBM Watson Health, hospitals achieving operational and care quality excellence have several characteristics in common, including “fewer patient complications, lower hospital readmission rates, and reduced in-hospital and aftercare expenses.”
Kyu Rhee, MD, MPP, VP and Chief Health Officer at IBM Watson Health, stated in an official press release, “In this era of big data, analytics, transparency, and patient empowerment, it is essential that we learn from these leading hospitals and work to spread their best practices to our entire health system which could translate into over 100,000 more lives saved, nearly 40,000 less complications, over 150,000 fewer readmissions, and over $8 billion in savings.”
Management thinker Peter Drucker is often quoted as saying that “you can’t manage what you can’t measure.” Our outcomes report is one of the many ways that we strive to stay ahead of the curve and improve our performance in joint replacement care. By measuring patient outcomes and carefully quantifying any complications and readmissions, we offer arthritis patients the very best experience in hip and knee replacement surgery. This year we are ecstatic that we were placed among the top performing joint replacement programs in the United States by CMS.
HIP/KNEE REPLACEMENT COMPLICATION RATE
- MMC has the lowest rate in Maine
- MMC is the only hospital in Maine to perform better than the national average
- MMC’S complication rate is the in the best 2.3% of all hospitals in the U.S.
HIP/KNEE REPLACEMENT READMISSION RATE
- MMC has the lowest rate in Maine
- MMC is the only hospital in Maine to perform better than the national average
- MMC’S readmission rate is in the best 1.6% of all hospitals in the U.S.
Source: https://www.medicare.gov/hospitalcompare Accessed: October 12, 2020
Our team’s dedication to patient care, innovation, medical knowledge, technical skill, and above all, desire and ability to improve, allow us to be one of the top joint replacement programs in the country. The desire and ability to change for the better is wholly dependent on understanding and reacting to our results in real time. In addition to monitoring surgical outcomes, our joint replacement surgeons collect patient-reported outcomes before and after surgery. Patient-based questionnaires monitor:
- Overall mental and physical health
- Joint-specific pain, stiffness and function
One of the major goals of collecting this data is to offer patients alternative objective measures of surgical outcomes to compare to other programs. In 2019, 95% of MMP joint replacement patients filled out patient-reported outcome questionnaires, an impressive statistic representing our practice’s commitment to getting patient input to constantly evaluate joint replacement surgery.
AVERAGE SATISFACTION SCORES 1 YEAR AFTER JOINT REPLACEMENT SURGERY (0-10)
Maine Medical Partners measures and monitors satisfaction after joint replacement surgery. On a scale from 0 to 10 (0 being the least satisfied and 10 being the most satisfied), patients indicate how satisfied they are with their pain relief and functional improvement, that the surgery met their expectations, and satisfaction with their provider. We think this data speaks for itself.
Knee replacement surgery has traditionally been associated with hospital stays averaging three to four days. In addition, a subsequent stay in a rehabilitation facility for additional recovery was not uncommon.
The staff at the MMC Joint Replacement Center has worked to develop a Next Day Knee Replacement program, with comfortable discharge home following surgery. The program is a natural evolution of the minimally-invasive anterolateral hip replacement that our colleague, Dr. George Babikian introduced to MMC in 2006.
The success of the total hip replacement program revolves around patient education, multimodal pain control, reduced trauma to the soft tissues at the time of surgery, consistent messaging by staff, and a smooth episode of care pathway.
A team from the MMC Joint Replacement Center, including an anesthesiologist, physician assistant, nurse, physical therapist, patient educator, and researcher traveled to the Cleveland Clinic to observe a mature next day knee replacement program. What we found was a program that was similar to our own with some subtle variations that allow patients to be safely discharged home the day after surgery.
We incorporated lessons learned from this visit along with our own experience at MMC to develop our Next Day Knee program. The program was introduced in the fall of 2018 when our average length of stay for a knee replacement was 2.2 days and we were able to safely reduce the length of stay to 1.2 days over the course of the year.
While we were able to successfully transition our program to a next day pathway we did not compromise on quality, our readmission rate and reoperation rate were 1.2% and 0.25% respectively. We continue to develop this program and have been closely monitoring our outcomes in terms of length of stay, discharge disposition and patient satisfaction.
PERCENTAGE OF KNEE REPLACEMENT PATIENTS DISCHARGED TO SKILLED NURSING FACILITY OR REHAB
Sixty-one percent of patients discharged home utilize home health care services, which can provide an array of health care services to ensure a safe and smooth recovery. 2016-2020 data (EPIC)
Solving Issues from the Shoulders to the Fingertips
Our program offers comprehensive services addressing all problems of the upper extremity (i.e. “shoulder to fingertips”). Using state-of-the-art techniques, our team of surgeons, therapists, physician assistants and support staff are capable of managing issues related to fractures, sports injury, pediatrics, post-traumatic reconstruction, etc. Our team is located at the MMP Orthopedics & Sports Medicine office in South Portland.
Meet the Team
Ross Feller, MD
• Hand, wrist, forearm, elbow and microvascular surgery
• Works with Amanda Keene, PA
• Maria Corridore, CHT, is a therapist specializing in hand and upper extremity conditions
Jon Watling, MD
• Shoulder and elbow surgery, with an emphasis on rotator cuff repair and shoulder arthroplasty
• Works with Melanie Campbell, PA and Rupinder Gill, PA
Greg Sawyer, MD
• Shoulder and elbow surgery, with an emphasis on rotator cuff repair and sports-related shoulder injuries.
• Works with Mark DeBiasio, PA
Linc Avery, MD
• Shoulder surgery, with an emphasis on rotator cuff repair and sports-related shoulder injuries.
COST IMPLICATIONS OF VARYING THE SURGICAL TECHNIQUE, SETTING, AND ANESTHESIA TYPE FOR CARPAL TUNNEL RELEASE SURGERY
Data represent mean ± standard error of the mean (SEM). # Reference group, normalized to 1.0. *p<0.05 as compared to left-sided neighboring value per Kruskal-Wallis tests and Nemenyi post-hoc multiple comparison tests. Values over graph bars represent fold-change differences relative to the reference group (WALANT).
Dr. Watling now offers GPS navigated shoulder replacement surgery. A CT Scan is used to perform virtual preoperative planning, which can then be executed in the operating room using real-time visual guidance feedback. This latest advancement in technology combines surgeon expertise with computer modeling software to improve implant placement, aid in reconstruction of complex anatomic deformity, and ultimately facilitate improved patient outcomes.
PERCENTAGE OF SHOULDER REPLACEMENT PATIENTS ABLE TO DO ACTIVITIES COMFORTABLY
Data is from the Simple Shoulder Test, a standardized tool used to assess shoulder function related to activities of daily living.
Our Sports Medicine division is advancing the practice of sports medicine in Maine with innovative procedures that decrease patient recovery times and produce better outcomes. We’re addressing acute sports injuries with emerging biologic treatment options that preserve more native tissue and use the body’s natural healing power to achieve better long-term results. And we’re leveraging minimally and non-invasive procedures
Located at 119 Gannett Drive in South Portland, we’ve added a 1.5T MRI scanner, which allows us to accommodate patients’ MRI needs much more quickly and efficiently. We are also in the midst of an expansion into the Sebago Lakes region, with plans to offer sports medicine care and physical therapy in a new Windham office by the end of the 2020 fiscal year.
Within this past year, we opened The Training Room Walk-In, an orthopedic walk-in clinic, also located at our 119 Gannett Drive office in South Portland. Prior to the COVID-19 pandemic, this clinic was available Monday through Friday, noon-7 PM. We are currently phone screening all patients and taking visits by appointment only until further notice. The facility allows patients with acute orthopedic injuries to be immediately seen by an orthopedic and sports medicine specialist without an appointment. With the goal of being able to accommodate the urgent needs of our patients, our office saw over 1,000 same-day patient visits in 2019.
We continue to be the leading team physicians for a growing list of local high school, colleges, and professional teams in the greater Portland area, and staff, many with an Athletic Trainer Certification (ATC). This allows easy communication between the team trainers and our physicians, allowing for expedited high-level quality care for injured local athletes and their families. This resulted in over 2,300 office and physical therapy visits in 2019.
Sports Medicine Surgery
We continue to offer comprehensive surgical care with both open and arthroscopic interventions for the knee, shoulder, hip, elbow, and ankle. Our sports surgical service line performed over 900 surgical interventions during 2019 - helping athletes and weekend warriors alike get back to their pre-injury levels of function.
The non-surgical team continues to provide a full spectrum of treatment options for non-operative management of joint injuries including ultrasound-guided injections, PRP (platelet rich plasma) treatments, TENEX procedures, and osteopathic manipulation. PRP injections are becoming a further validated option for treatment of tendinopathy and intra-articular joint pathology, and our non-operative team performed 119 of these biologic injections in 2019. TENEX is a minimally-invasive intervention option for treatment of chronic tendinopathy. Kate Quinn, DO is the only TENEX provider in the state of Maine, and performed 16 such procedures in 2019.
On October 10, 2019 at the national meeting of the Orthopedic Trauma Association (OTA), Dr. Raymond White was awarded the Community Surgeon Achievement Award. This award is presented annually after nomination by his/her peers for those surgeons who have:
- Demonstrated outstanding community orthopedic contributions
- Dedicated their professional life to excellence in research and education at all community levels
- Personal qualities of integrity, compassion and leadership in orthopedic trauma
Dr. White is only the third recipient of this prestigious award, which is given annually to only one of the 2,500 international OTA members. The OTA is comprised of the world’s leading orthopedic trauma surgeons and is devoted to providing the highest level of care for injured patients.
This is not the first time that Dr. White has been recognized by his peers. In fact, he has remained active as Chairman of the highly regarded New England Fracture Summit, an annual conference dedicated to the education of community surgeons for the purposes of optimizing patient fracture care. This course is made up of leading fracture surgeons from around New England as well as invited expert faculty from away. For many, this course is a required educational endeavor each year.
In addition, he authors book chapters and prominently lectures both nationally and internationally. Locally, as the senior most orthopedic surgeon at Maine Medical Center, he is a mentor to both surgeons and staff.
Please join us in congratulating Dr. White for his well-deserved international achievement.
Orthopedic Trauma Rounds Webinar
Our group of orthopedic traumatologists recently sat down to discuss future projects. At the time, we were busy with complex referrals from our colleagues around the state. We wondered aloud how to connect more closely with our community surgeons who send us difficult fracture cases.
At our annual New England Fracture Summit in Stowe, VT, we get to meet and interact with surgeons who have common interests in fracture care, but we rarely get to connect with those surgeons again until the following year. At the same time, our organization has spent considerable time discussing the complex issues around MaineHealth practice alignment. We realized that though we practice in a small state with a small orthopedic community, we remain quite isolated in Portland and at Maine Medical Center.
To address this perceived ‘separation’ and in an effort to try to bring our community of surgeons closer together, we began discussing ways to communicate more directly with our MaineHealth orthopedic colleagues. Previously, as educators in orthopedic fracture care, two of us had participated in online teaching. In addition, twice monthly, orthopedic trauma fracture conferences in Portland allowed us to get together with our local colleagues to review and discuss past and future cases as part of an ongoing effort to stay current and to educate one another.
What we realized was that our trauma conference could be interesting and even applicable to many of our colleagues who could not make the drive to Portland every other Thursday. Therefore, we decided to try to leverage technology the same way that large organizations have done to broadcast our fracture conference to those that are interested in seeing what we do. In this way, the Orthopedic Trauma Rounds Webinar was born.
First, we gathered information from around the region asking what kind of educational content would be of value. With that information, we developed a series of objectives that would serve the majority of the potential participants. These objectives included:
1. Reviewing a group of complex fracture cases and how they were managed
2. Discussing tips and tricks for complex fracture management
3. Bringing our community of orthopedic surgeons closer together
We agreed to have the conference broadcast using the GoToMeeting platform that had been successful in previous years as a way for participants to view the content and to participate remotely via computer with questions live via a connected computer monitor. We chose to host the meeting at our site in Portland, understanding that in the future, it could be hosted from virtually anywhere. Having done the requisite preparation, we were able to obtain verification from our hospital CME department to provide hourly credit for those individuals who participate in the webinar.
However, as we came closer to the date of our first webinar, the COVID-19 crisis struck. Schools were shut down. Formal social distancing was instituted. Elective surgeries were postponed. And importantly, all group meetings, including orthopedic trauma and grand rounds, were cancelled for the foreseeable future. With this as our background, it seemed more important than ever that we follow through on our ideas from the previous summer.
And so on April 2, 2020 at 0700, our first Maine Orthopedic Trauma Webinar went live. With over 30 remote participants and others participating in person, we presented several complex fracture cases, allowing for comments and Q&A from the group. Though it was clear that there are improvements to be made, the session was well-received. Participants were able to provide feedback via online survey after which they were able to claim their CME credit. Given the current state of COVID-19, we plan to continue this orthopedic trauma webinar going forward on the first Thursday of each month starting at 0700.
For more information, please contact Amanda Junkins at JUNKIA@MMC.ORG.
All orthopedics and sports medicine procedures present unique risks, and such risks may affect a particular patient’s outcome. Outcome report data presented in this report is from Maine Medical Partners, a department of Maine Medical Center.