Latest / Becker’s Healthcare Podcast / Closing the Gap: The Case for Post-Fracture Care

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Closing the Gap: The Case for Post-Fracture Care · Becker’s Healthcare Podcast

• 0:00
  Welcome everyone to the Becker's Healthcare Podcast.
• 0:02
  Today's episode explores why health systems should prioritize
• 0:05
  post fracture care programs.
• 0:07
  This episode is sponsored by Amgen as a
• 0:09
  part of a podcast series on post fracture
• 0:11
  care. And with that, I'll turn the floor
• 0:13
  over to Amgen's Kristen Buesman.
• 0:16
  Hello, everyone. It's a pleasure to be here
• 0:18
  again today with the Becker's Healthcare podcast.
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  My name's Kristen Buseman, and I am the
• 0:23
  marketing director for health systems and key accounts
• 0:25
  for Amgen's bone health franchise in The US.
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  And I'm so delighted here to be talking
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  with two of my favorite folks. We've got
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  Matt Brunz and Jared Torkelson. You guys wanna
• 0:35
  introduce yourself here for our listeners?
• 0:37
  I'm Jared Torkelson. I'm a physician assistant with
• 0:39
  orthopedic surgeon and sports medicine department at Mayo
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  Clinic Health System in Mankato, Minnesota.
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  I'm Matt Brunz. I'm a certified orthopedic nurse
• 0:47
  practitioner and clinical densitometrist
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  at SSM Health Orthopedics in Saint Louis, Missouri.
• 0:51
  Excellent. Thanks, Matt and Jared, for joining us
• 0:54
  today. So today, we're gonna have a really
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  great conversation. You guys have both been very
• 0:58
  involved in establishing post fracture care programs within
• 1:01
  your respective organizations.
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  Before we get into the details on why
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  leaders should really understand
• 1:06
  the challenges of osteoporosis
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  management
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  and why post fracture care is a solution
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  to help them manage this patient population, I
• 1:13
  wanna get a little bit more background on
• 1:15
  the disease state itself.
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  So could you guys kind of share for
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  our audience the challenges that this patient population
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  is facing and the impact that it has
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  on our health systems and on patients?
• 1:28
  Yeah. Kristen, I I think the answer is
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  simple. The the leaders should care about post
• 1:32
  fracture care because closing these care gaps means
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  fewer fractures,
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  for patients
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  and a stronger, more sustainable health care system
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  in general. You know, the burden of of
• 1:42
  osteoporotic fractures is fairly significant. Every twenty seconds
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  in The US, a woman over age 55,
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  will suffer an osteoporotic related fracture.
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  And the majority of these women over the
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  age of 50 do not receive formal osteoporosis
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  care. I think that's something we we both
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  see in our practices,
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  very frequently. You know, thirty five percent of
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  subsequent fractures occur within that first,
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  year,
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  of the five year follow-up after that initial,
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  or sentinel fracture.
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  And that's a pretty significant burden. Sure is.
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  Yeah. And I don't know like to talk
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  about money in in health care, but that's
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  a big part of this too. Right? So,
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  you know, by 2040, it's projected that osteoporosis
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  related fracture care is gonna cost over 95,000,000.
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  And I think in the current state of
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  money, we have to find ways to really,
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  you know, garner those resources as best we
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  can and and prevent those fractures as well.
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  So post fracture care is in a great
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  position. They got potential to close that gap,
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  reduce the fractures, and also reduce the costs.
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  Yeah. That makes a lot of sense. Thank
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  you for sharing that background.
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  So as I mentioned earlier, I know you
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  both have been instrumental in starting post fracture
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  care programs and and running them at your
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  organizations. So I'd like to have you both
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  kind of share a little bit about what
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  that looks like. And let's see. We're gonna
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  go to Jared first.
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  Yeah. So I don't have a bunch of
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  little hats at at my job there. But,
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  I work with a busy arthroplasty surgeon part
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  of the time. The other time, I run
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  our bone health and FLS clinic we've done
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  for the last eight years. We have an
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  infusion center as well where we do a
• 3:05
  lot of our injections for our patients too.
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  So we try to keep everything under under,
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  one umbrella as you can. We offer a
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  lot of in person and then since COVID
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  to a lot of telehealth options for our
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  patients they really love. And we have a
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  a large area, a large rural area, so
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  patients are sometimes having to drive, you know,
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  an hour or two hours to come and
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  see me. So that's been really pivotal, I
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  think, in the last couple years.
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  We took a lot of time beginning to
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  set really dedicated protocols. One for efficiency and,
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  well, with our patients, but also with our
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  staff too.
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  You know, we respect the patient's time. We
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  wanna make sure that they're getting the correct
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  tests.
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  Prior authorizations in a fuel processor, another big
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  part that we took a lot of time
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  in the beginning to make sure that those
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  were key and ready to go. The visits
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  are really thorough, and they're thorough because they
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  should be. You know, it's tough because with
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  osteoporosis in the past,
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  it no one really owned it. Right? It's
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  been a primary care issue. It's been an
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  orthopedic issue. It's been an endocrinology issue. So
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  trying to take that time with the patient
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  and bring all those things together so they
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  really you know, we know what's going on
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  with that patient. We're treating them well. We're
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  not missing something along the way. Last year,
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  we saw five hundred new patients in our
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  bone health clinic. Most of those patients were
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  hip and wrist fractures. We do see some,
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  a fair amount of vertebral fractures and then
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  to a lesser extent, periprosthetic
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  fractures and other fragility fractures too. We are
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  performing some spine optimization. You know, spine care
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  is is something that's really pivotal to all
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  of this too. And we're also starting to
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  slow it again to perioperative arthroplasty optimization in
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  our high risk patients, which is something that's
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  been a big push the last couple of
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  years in the bone health world.
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  You know, as we know, refractory risk in
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  that first two years after that fracture,
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  roughly one in ten patients are gonna refractory
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  in that first year. And as that number
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  grows, you can see that first two years
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  after that fracture is really pivotal. So we're
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  trying to get those patients as soon as
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  we can. We try to get within six
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  weeks.
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  Usually, the first two weeks after that fracture,
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  the patient's trying to get their life back
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  together so we can give that time to
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  settle in. And then we wanna get them
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  ready to go and get them treated appropriately.
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  So, you know, with our numbers conservative, if
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  we were to save fifteen hip fractures, that's
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  roughly
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  60 hospital bed stays that we've prevented within
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  our our our hospital. So that's a cost
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  savings, but I'm told too that,
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  you know, you're protecting your margins as well
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  too. So, again, we don't like to talk
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  about money, but if you can take those
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  beds, one, the the the patient's in a
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  better position because they never had that fracture.
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  But, two, you're saving that for your elective
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  procedures that are gonna be more valuable to
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  the the hospital system overall.
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  That's great. Thanks so much, Jared. It sounds
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  like a lot of really great work,
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  benefiting patients and really, help streamline things at
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  Mayo as well. So, Matt, do you wanna
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  tell us a little bit about your post
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  fracture care work? Yeah. I think that, you
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  know, the unique thing about post fracture care
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  when we use that has some variability. And
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  there are several post fracture care models where
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  they talk about the outpatient setting. And our,
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  post fracture care program starts as soon as
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  the patient hits the emergency room door with
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  that hip fracture. And I think it's important
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  that inpatient care is streamlined. And so we've
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  worked very diligently to create a system wide
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  program
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  of order sets and care plans
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  that tries to get that patient from the
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  ER to the OR within a twenty four
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  hour period. And,
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  we
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  have streamlined care plans that then look at
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  trying to to reduce delirium and confusion while
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  they're in the hospital to reduce length of
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  stay. And so that has a a significant
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  impact on their overall,
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  care. And then we have care managers and
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  nurse navigators that,
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  work with the patients and educate them about
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  their underlying,
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  osteoporosis
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  and the importance of addressing that. You know,
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  unfortunately, these audiences,
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  when they're there with a hip fracture,
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  are often not receptive to education. And so
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  providing them take home material that they and
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  their family can lean back on,
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  to address their
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  upon follow-up in the outpatient setting is extremely
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  important. And so educating these patients and raising
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  awareness to them that, yes, while this is
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  a bad fracture and we were fortunate enough
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  to get it back together,
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  but here's the long term, you know, process
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  of addressing the underlying issues. And and so
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  we really were focused on education
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  and, trying to get these patients or to
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  recognize the importance of addressing the underlying,
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  osteoporosis issue to prevent these subsequent fractures from
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  happening, which we obviously know are are they're
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  at high risk for.
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  That's great. Thanks so much, Matt. So you
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  kind of touched on this a little bit,
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  the issue of,
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  how post fracture care programs can really help
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  streamline workflows and processes within the system. I
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  don't know. Jared, would you like to maybe
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  touch on that a little bit more, kind
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  of your perspective on how post fracture care
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  can really improve
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  care for patients?
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  So at the end of the day, patient
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  benefits and health system benefits, they're they're very
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  much intertwined.
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  You know, we've found helpful at Mayo Clinic
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  is thinking about that connection between the patient
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  health system. You start with the number of
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  hip fractures we see each year. So
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  the the data shows that a a a
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  good well running FLS service or bone health
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  clinic can prevent roughly thirty percent of your
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  refractures.
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  So let's say annually, you see a hundred
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  hip fractures. So twenty, thirty of those patients
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  are avoiding that second fracture, which is fantastic.
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  Another example is if you're practicing performing spine
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  optimization, you're going to revision spine surgery. So
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  you have a patient that maybe at the
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  time of their elective procedure just wasn't optimized,
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  wasn't ready to go, and they go on
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  to proximal juncture kyphosis or some other thing.
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  You know, a single revision surgery can cost
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  30 to $40,000
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  in direct medical costs. So that's just to
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  the patient. You also gotta think about, you
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  know, resource allocation. You gotta think about,
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  the time on the caregiver as well too.
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  So a lot of times, if the the
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  patient can't take care of themselves, are they
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  going to a swing bed? You can prevent
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  those costs. Also, the caregiver cost of having
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  to take time off work, having to to
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  travel to help with the patient, getting all
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  those other things too. We can avoid a
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  lot of that with optimizing these patients.
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  That's great. And, Matt, have you guys taken
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  a look at some metrics?
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  Could you tell us a little bit about
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  that? Yeah. We are in the process of
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  developing a fairly robust
• 8:41
  dashboard to look at our metrics, both in
• 8:44
  the inpatient setting and in the outpatient setting.
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  We do know that our through our automatic
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  EMR driven order sets that we have increased
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  the efficiency,
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  optimized the workflow
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  of getting these patients to follow-up.
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  So closing that care gap that exists between
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  the inpatient and the outpatient setting,
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  the current things we have in place, we
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  we certainly see the fruit of that and
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  the bone health clinic and, with the follow
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  ups.
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  Hopefully, in the real near future, we'll be
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  able to put a number to our successes
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  once the dashboard is up and running.
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  That's fantastic. Thank you so much. So we've
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  talked a little bit about the importance of
• 9:21
  post fracture care from both the patient perspective
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  and from the health system perspective.
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  Can you tell me a little bit about,
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  again, how leaders of health systems should think
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  about post fracture care aligning to those goals?
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  Because we know that patients and,
• 9:36
  health system efficiency are obviously big important goals
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  for health system leaders. So how should we
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  really be thinking about this as a health
• 9:43
  system executive?
• 9:44
  Yeah. So I think, you know, PFC programs
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  naturally complement health systems' emphasis on the the
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  value based care that we need to provide.
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  And more and more every year, you know,
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  focus on providing the the quality outcomes and
• 9:54
  managing your costs effectively.
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  You know, leaders can strategically align with, PFC
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  programs and the broader health initiatives such as
• 10:00
  chronic disease management and addressing complex patient needs
• 10:03
  comprehensively.
• 10:04
  You know, this alignment shows an holistic approach
• 10:07
  approach to the patient care and strengthens your
• 10:09
  organization's commitment to community health improvement overall.
• 10:12
  Yeah. I think that certainly developing a strong
• 10:14
  tracking,
• 10:15
  and measurement framework is crucial for monitoring the
• 10:17
  success of these PFC initiatives
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  and identifying areas for improvement. You know, if
• 10:22
  we can, you know, obtain the data to
• 10:24
  see where we fall short, I think that
• 10:26
  that's extremely important to continually improve our processes.
• 10:30
  But,
• 10:31
  you know, leveraging our technology,
• 10:33
  and using our EMR
• 10:35
  when we have the opportunities to utilize telemedicine,
• 10:37
  I think it's extremely important to,
• 10:40
  facilitate visits for these patients that sometimes struggle
• 10:43
  to get to,
• 10:44
  the outpatient or the clinic setting. I think
• 10:46
  that's extremely important. And, regular program evaluation allows
• 10:50
  us to assess the effectiveness of the overall,
• 10:53
  program and adapt,
• 10:55
  you know, where we're falling short, to meet
• 10:57
  the needs of the kind of evolving landscape
• 11:00
  and and,
• 11:01
  the the goals of our organization in general.
• 11:04
  But ensuring continuous education and professional development opportunities
• 11:07
  for staff is also
• 11:09
  key,
• 11:10
  increasing awareness to to how these programs can
• 11:12
  benefit and and positively impact patient lives, I
• 11:14
  think, is extremely important.
• 11:16
  That's great. Thanks so much. So we're here
• 11:19
  at the Becker CEO CFO roundtable where we've
• 11:22
  got health care leaders from all over the
• 11:23
  nation coming together to learn about how they
• 11:26
  can continue to improve care at their own
• 11:28
  organizations.
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  So what would be a piece of advice
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  you have for them and any of our
• 11:32
  listeners on how to really start thinking about
• 11:34
  post fracture care and implementing post fracture care
• 11:36
  at their organizations?
• 11:38
  Yeah. I think with with any big project,
• 11:40
  right, you gotta start small. You know, the
• 11:42
  osteoporosis care gap, that's a big gap. You're
• 11:44
  you're not gonna solve it in a day
• 11:45
  or even within a year. So so start
• 11:47
  small. Build your processes small.
• 11:49
  I kinda like to think of the the
• 11:51
  faucet analogy. Right? So build your faucets beginning
• 11:53
  and slowly turn them on over time. So
• 11:54
  start with hip fractures or wrist fractures that
• 11:56
  are, you know, patients that really need this
• 11:58
  care, and easy to get through. Figure out
• 12:01
  your pathways. Figure out what works, what doesn't.
• 12:02
  What can your health system do, what can
• 12:04
  it do, and then slowly expand out from
• 12:05
  there. I I don't know if Matt believes
• 12:07
  this, but I've I've never really advertised for
• 12:09
  my clinic, and I'm booked out months. So
• 12:11
  they they will find you. I think osteoporosis
• 12:13
  is is something where, you know, historically, the
• 12:16
  the people wanna do the right thing, but
• 12:17
  either they didn't get a lot of education
• 12:19
  on it within their training, or they're just
• 12:21
  not comfortable. And that's okay. So that's where
• 12:22
  where people like Matt and I come in,
• 12:24
  and we're happy to help these patients. You
• 12:25
  gotta measure what you're doing. So I think
• 12:27
  to show growth and especially to show your
• 12:29
  your, you know, executives or your your your
• 12:31
  leadership that, hey. We're doing a good thing.
• 12:33
  Patients are saying that too with patient satisfaction.
• 12:35
  You're you're creating that that that experience for
• 12:37
  the patient, but also that connection,
• 12:39
  but also that you're you're reducing your fracture
• 12:41
  risk or you're reducing the amount of of
• 12:42
  hospital stays. Those things measuring are are very
• 12:44
  important going forward too. It's great. Matt? Yeah.
• 12:47
  I think, you know, a lot to Jared's
• 12:49
  point about starting out small and working your
• 12:51
  way up. I think that, you know, finding
• 12:53
  a a physician champion or the leader that's
• 12:56
  going to to take this forward is extremely
• 12:58
  important. You know, don't start from scratch. There
• 13:01
  are lots of models that have been well
• 13:03
  documented their successes, and you can kind of
• 13:06
  try and take some cookie cutter things from
• 13:08
  those, and you don't have to reinvent the
• 13:10
  wheel. But, you know, one thing that we
• 13:12
  found very successful is we designed our program
• 13:14
  initially,
• 13:16
  with the entire health system in mind, knowing
• 13:18
  that we may not have all the resources
• 13:20
  in place,
• 13:21
  in each of our locations
• 13:23
  to fully provide, you know, a comprehensive bone
• 13:26
  health program or post fracture care program. But
• 13:30
  it was designed initially with that,
• 13:32
  in mind so that it could be scalable.
• 13:34
  So all the order sets when they were
• 13:36
  initially built were to be implemented system wide,
• 13:40
  recognizing that as time grows and as we,
• 13:43
  you know, put more emphasis on this, area
• 13:46
  that we'll find the resources that will continue
• 13:49
  to fill in over time, and we'll have
• 13:50
  a much more robust program when it's all
• 13:52
  said and done.
• 13:53
  That's great. I wanna thank you both so
• 13:55
  much for sharing your insights today.
• 13:58
  And thank you also for your dedication and
• 14:00
  commitment to serving this, osteoporosis patient population. So
• 14:04
  I think the work that you're doing in
• 14:05
  post fracture care and sharing your insights here
• 14:07
  is gonna help a lot of, patients and
• 14:09
  help a lot of health system leaders as
• 14:10
  they consider how to continue to go forward
• 14:12
  and really implement post fracture care solutions across
• 14:15
  their health systems. So thanks so much again,
• 14:17
  guys. Really appreciate it. Thank you. Thanks for
• 14:20
  having us. Thank you, Kristen, mister Dorkelson, and
• 14:22
  mister Brunz for this informative and actionable conversation
• 14:26
  on implementing post fracture care programs.
• 14:28
  We also wanna thank our podcast sponsor, Amgen.
• 14:31
  This episode is part of a four part
• 14:33
  series sponsored by Amgen on post fracture osteoporosis
• 14:36
  care. You can tune in to more podcasts
• 14:38
  from Becker's Healthcare on post fracture care and
• 14:41
  other topics by visiting the podcast page at
• 14:44
  www.beckerspodcast.com.