From AAHKS 2016 – CODE had the delight to talk with Dr. Jay Lieberman, Professor and Chair of the Department of Orthopaedic Surgery at Keck Medicine, University of Southern California. The fully transcribed interview is included.
Dr. Brian Cunningham: Hey guys, live from AAHKS 2016, we’re fortunate enough today to be joined by Dr. Lieberman, the chairman of the department of orthopedic surgery at the University of Southern California.
We’re taking a few minutes after a great session talking about everything from value to bundled payments to patient-reported outcomes. We wanted to pick Dr. Lieberman’s brain about a few topics specifically related to those points we heard about yesterday.
Dr. Lieberman, as a leader of a big department at an academic center, what role do you see for patient-reported outcomes as we go forward in healthcare?
Dr. Jay Lieberman: Well, they’re absolutely gonna be critical in every aspect of orthopedic surgery. Obviously there’s a huge focus right now in total joint replacement because of the bundled payment initiatives. It’s actually required for you to collect (if you’re in CJR, comprehensive joint replacement, the initiative started by CMS) the bundle of patient-reported outcomes, both pre- and post-operable.
Cunningham: I think a lot of groups, especially, say, a smaller private practice, feel like they don’t have the infrastructure, they have so many challenges to try to collect that information. What do you see as some of the barriers for you guys specifically to collecting patient-reported outcomes, and then maybe for a smaller practice that’s trying to do it?
Lieberman: In the various academic places I’ve been in over the years, we’ve been collecting patient-reported outcomes for two decades. The basic problem is that you need staff dedicated to it.
Cunningham: Full-time employees.
Lieberman: Some type of arrangement.
Cunningham: Got it.
Lieberman: Right now we’ve adapted a new strategy where we have, we like doing it in the office, and the patients seem to like it. The weakness is you don’t get real-time data. I think that’s the Holy Grail. What I would like the most in the practice would be to have the patients fill out the forms and then when I come to see them …
Cunningham: You can look at it.
Lieberman: In the office, I would have it on the computer screen. Right now we’re collecting all the data on iPads, and that’s worked well. We’re collecting the data required by CMS for CJR and it takes the patients around five minutes, which is a huge advance from when I started.
Lieberman: Your audience probably don’t know what pen and paper are, because they’re digitally oriented, but there’s this thing, we used to have this thing called a pencil and a piece of paper, and the patients would actually fill in these little oval circles and that’s how we’d figure out. Then that would be scanned into the computer, and that’s how we would get our data.
Now the patients actually press the buttons and that’s worked out very well But obviously there are multiple initiatives to try to get patients to try to fill out the data, and some of it’s should it be done at home before the office. That also would work well for us. Then I could even have it the morning before clinic.
Lieberman: I actually would view the data. Because I think what the patients really would like is how am I doing compared to the last visit?
Lieberman: What I’d like to be able to do is tease out, maybe they’re having a little trouble with some type of activity, and then you would actually focus your visit on that. Because many times I think that gets missed in a short follow-up visit.
Cunningham: Do you guys utilize any of that information to compare surgeon to surgeon within your institution?
Lieberman: Right now, we’re not doing surgeon to surgeon comparison, because first of all, that’s a little difficult. Not all the patients are the same, right?
Cunningham: Right, absolutely.
Lieberman: Even if you did a pre- and post-operative comparison, in some way, you have to risk-adjust, and that’s difficult.
Cunningham: Very difficult.
Lieberman: I think the focus right now is to try to educate patients and to make them better. We also submit our data to the American Joint Replacement Registry, which I think is going to be more and more useful, and then you’re able to compare your practice to different practices.
Lieberman: But again, I think one of the issues is, what are the comorbidities?
Cunningham: For sure.
Lieberman: Not everybody’s exact, even if you said, “Well, they started out at a certain level,” there may be different reasons why the patient’s at a certain level, and you could do an excellent operation, but maybe the patient’s obese, or they have cardiac disease, and they can only get to a certain functional level.
In addition, mental status, patient’s general attitude about life has an impact on outcomes. It’s an area of some concern of how people are gonna use the data. Because we’ve done expectation studies in total joint replacement patients, and they actually change over time.
Lieberman: So a patient’s very happy about the procedure, and then all of a sudden they really want to beat their friend in singles tennis and they can’t do that now, and then their so-called satisfaction levels actually go down, even when the result is superb.
Cunningham: Oh, man.
Lieberman: It’s an area that requires further study and we have to be careful about how we use the data that we’re collecting.
Cunningham: Absolutely. We’d like to thank Dr. Lieberman for taking some time with us. We’ll catch up with our next guest shortly, and thank you again for your time. Appreciate it.
Lieberman: Thank you.