Impact of an integrated practice unit on the value of musculoskeletal care for uninsured and underinsured patients

Devin V. Williams, Tiffany C. Liu, Michael G. Zywiel, Miranda K. Hoff, Lorrayne Ward, Kevin Bozic, Karl Koenig

Research output: Contribution to journalArticle

Abstract

Background: Limited access to specialty care for uninsured and underinsured patients may be exacerbated by traditional fee-for-service approaches to care that incentivize volume and intensity of services over value of care. The purpose of this study was to determine the impact of a value-based integrated practice unit (IPU) on access to musculoskeletal care and surgical outcomes in a safety-net population. Methods: A new IPU was implemented on 6/1/2016 at an established safety-net clinic providing musculoskeletal care in central Texas to supplement existing musculoskeletal care provided through a fee-for-service model. This retrospective cohort study compared access and outcomes under the IPU to the parallel fee-for-service clinic through 3/31/2017, as well as the historical fee-for-service clinic from 8/1/2015 through 5/31/2016. Primary outcomes for access included number of referrals addressed; for surgical patients, length of stay, discharge destination, and 30-day readmission rates were assessed. Results: The baseline waitlist of 1401 referrals on 6/1/2016 was eliminated by 3/31/2017. Among patients undergoing hip or knee replacement, length of stay was 1.4 days compared to 2.6 days for patients referred to the parallel fee-for-service clinic (p < 0.001), and 92% were discharged home versus 89% (p = 0.46). The 30-day readmission rate for the IPU was 2.7%, which did not differ significantly from the HFFS (8.5%, p = 0.23) and PFFS (3.7%, p = 0.64) clinics. Conclusions: An IPU increased access and improved short-term surgical outcomes in a population of uninsured and underinsured patients seeking musculoskeletal care. Additional studies of longer duration are needed to assess the sustainability of a value-based approach. Implications: A value-based approach to musculoskeletal care may improve access and outcomes in safety-net patients. Level of evidence: III, retrospective cohort study

Original languageEnglish (US)
Pages (from-to)16-20
Number of pages5
JournalHealthcare
Volume7
Issue number2
DOIs
StatePublished - Jun 1 2019

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Fee-for-Service Plans
Length of Stay
Cohort Studies
Referral and Consultation
Safety-net Providers
Retrospective Studies
Patient Safety
Population
Hip
Knee
Safety

ASJC Scopus subject areas

  • Health Policy

Cite this

Impact of an integrated practice unit on the value of musculoskeletal care for uninsured and underinsured patients. / Williams, Devin V.; Liu, Tiffany C.; Zywiel, Michael G.; Hoff, Miranda K.; Ward, Lorrayne; Bozic, Kevin; Koenig, Karl.

In: Healthcare, Vol. 7, No. 2, 01.06.2019, p. 16-20.

Research output: Contribution to journalArticle

Williams, Devin V. ; Liu, Tiffany C. ; Zywiel, Michael G. ; Hoff, Miranda K. ; Ward, Lorrayne ; Bozic, Kevin ; Koenig, Karl. / Impact of an integrated practice unit on the value of musculoskeletal care for uninsured and underinsured patients. In: Healthcare. 2019 ; Vol. 7, No. 2. pp. 16-20.
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abstract = "Background: Limited access to specialty care for uninsured and underinsured patients may be exacerbated by traditional fee-for-service approaches to care that incentivize volume and intensity of services over value of care. The purpose of this study was to determine the impact of a value-based integrated practice unit (IPU) on access to musculoskeletal care and surgical outcomes in a safety-net population. Methods: A new IPU was implemented on 6/1/2016 at an established safety-net clinic providing musculoskeletal care in central Texas to supplement existing musculoskeletal care provided through a fee-for-service model. This retrospective cohort study compared access and outcomes under the IPU to the parallel fee-for-service clinic through 3/31/2017, as well as the historical fee-for-service clinic from 8/1/2015 through 5/31/2016. Primary outcomes for access included number of referrals addressed; for surgical patients, length of stay, discharge destination, and 30-day readmission rates were assessed. Results: The baseline waitlist of 1401 referrals on 6/1/2016 was eliminated by 3/31/2017. Among patients undergoing hip or knee replacement, length of stay was 1.4 days compared to 2.6 days for patients referred to the parallel fee-for-service clinic (p < 0.001), and 92{\%} were discharged home versus 89{\%} (p = 0.46). The 30-day readmission rate for the IPU was 2.7{\%}, which did not differ significantly from the HFFS (8.5{\%}, p = 0.23) and PFFS (3.7{\%}, p = 0.64) clinics. Conclusions: An IPU increased access and improved short-term surgical outcomes in a population of uninsured and underinsured patients seeking musculoskeletal care. Additional studies of longer duration are needed to assess the sustainability of a value-based approach. Implications: A value-based approach to musculoskeletal care may improve access and outcomes in safety-net patients. Level of evidence: III, retrospective cohort study",
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AU - Williams, Devin V.

AU - Liu, Tiffany C.

AU - Zywiel, Michael G.

AU - Hoff, Miranda K.

AU - Ward, Lorrayne

AU - Bozic, Kevin

AU - Koenig, Karl

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