Latest / Becker’s Healthcare Podcast / Closing the Gap: Advancing Osteoporosis Care Across Practice Settings

Transcript

Closing the Gap: Advancing Osteoporosis Care Across Practice Settings · Becker’s Healthcare Podcast

0:00
Hi, everyone. This is Lucas Voss with Becker's
0:02
Healthcare. Thanks so much for tuning in to
0:04
the Becker's Healthcare podcast series. It's great to
0:06
have you. Today's episode explores how to optimize
0:10
post fracture care across practice settings. And this
0:13
episode is sponsored by Amgen as part of
0:16
a podcast series on post fracture care. And
0:19
with that, I'll turn the floor over to
0:21
Amgen's Kristen Buesman, director of IDN strategy and
0:25
marketing.
0:26
Hello, everyone. It's a pleasure to be back
0:28
here again on the Becker's podcast. My name
0:30
is Kristen Buseman, and I lead our health
0:32
systems and key accounts marketing team for our
0:34
bone franchise at Amgen.
0:36
And what that really means is we work
0:38
with health system leaders to understand where there
0:41
are care gaps in managing the osteoporosis patient
0:44
population that we can all work together to
0:46
solve for. So I'm really excited today to
0:49
be speaking with two folks that can share
0:51
their perspective,
0:52
particularly as it relates to the orthopedic practice
0:55
setting.
0:56
And today, our guests are gonna be Christina
0:58
Yazdani from the University of Texas Physicians Orthopedics
1:01
Group and doctor Greg Mines from Florida Orthopedic
1:03
Institute. So I'm gonna turn it over to
1:05
you guys. Christina, why don't you introduce yourself
1:07
first?
1:08
Hi, Kristen. Yeah. I'm excited to be here.
1:10
My name's Christina Yazdani. I'm a physician assistant
1:13
and certified clinical dentitometrist
1:16
in
1:16
orthopedic surgery. I'm part of the UT Physicians
1:20
Group with University of Texas Health Science System
1:23
in Houston,
1:25
Texas. Wonderful. Thanks for joining us, Christina.
1:28
And doctor Mines, how about you tell us
1:30
a little bit about yourself?
1:31
Hello, Kristen. And all the people listening, my
1:33
name is doctor Gregory Mines. I'm a medical
1:35
physician from St. Petersburg, Florida practicing on with
1:38
Florida Orthopedic Institute, and I host the post
1:40
fracture and bone health clinic there as well
1:42
as nonoperative sports medicine.
1:45
Wonderful. So thanks again for both of you
1:47
for joining us. We're really excited about this
1:49
conversation about how we can optimize post fracture
1:52
care across the practice settings. And I know
1:55
that you both have really interesting,
1:57
similar yet different perspectives to share on how
2:00
that can happen, especially in the orthopedic setting.
2:03
So to start us off, Christina, could you
2:05
share a little bit about what prompted the
2:07
establishment of your bone health clinic at UT
2:09
Physicians?
2:10
Help us understand kinda how you were able
2:12
to place post fracture care as a system
2:15
priority.
2:16
So our group, UT Physicians,
2:18
is affiliated
2:20
with a larger hospital system, Memorial Hermann,
2:24
in the Houston area. And Memorial Hermann is
2:26
actually one of two level one trauma hospitals
2:30
in the Texas Medical Center. And the Texas
2:32
Medical Center happens to be the largest medical
2:35
center in the world. So as you might
2:37
imagine, we see a very high number,
2:40
of trauma, and that includes the fragility fractures
2:44
and especially those hip fragility fractures.
2:47
And so what our orthopedic trauma team was
2:50
noticing,
2:51
was really the lack of follow-up that these,
2:54
hip fractures and these fragility fracture patients in
2:58
general
2:59
were getting once they left the hospital. And
3:02
that could be under treatment by their primary
3:04
care providers or just really long wait times
3:07
to get into specialists such as, geriatricians
3:10
or endocrinologists.
3:12
And so,
3:14
with with that poor follow-up care, we just
3:16
saw a bunch of repeat customers.
3:19
Lots of people that would have a hip
3:20
fracture, and then six months or a year
3:23
later, they're back for, you know, the other
3:25
side. And so we just decided to kind
3:28
of tackle it head on. And,
3:31
if we were the ones seeing the fractures,
3:33
that we could form our own clinic to
3:35
try to address that care gap, and that's
3:37
how we formed our UT Bone Health Clinic.
3:41
Excellent. Thanks very much for sharing that.
3:43
Greg, I'm gonna turn it over to you.
3:45
It would be great to get a little
3:47
bit of context around the PFC or post
3:49
fracture care program at your institution, which I
3:52
know has a little bit of a different
3:53
angle, especially incorporating the nonoperative
3:56
sports medicine component.
3:58
Yes. Thanks, Kristen. So I think it's similar
4:00
to Christina, but, you know, slightly tangential at
4:02
the same time that we we too had
4:04
a similar kind of recognition there. So I
4:05
work for all Ford Orthopedics. Ford Orthopedics, it's
4:07
the new Ford Orthopedic Institute, Saint Petersburg. And
4:10
with that, we're one of the larger practices
4:11
in Florida and across the country in terms
4:14
of private practices that are associated with a
4:16
lot of hospital systems. And so with that,
4:18
we regularly handle the orthopedic care and the
4:20
trauma call coverage for the local level one
4:23
and level two trauma centers.
4:24
Given Florida
4:26
demographics with retirees and snowbirds, we, saw a
4:29
significant increase in fragility fractures and fractures as
4:32
a whole
4:33
due to the high risk populations that located
4:36
in this area.
4:38
Like Christina said, unfortunately, we noticed repeat customers.
4:41
We saw this cycle of fracture with great
4:43
healing followed by an additional fracture. And so
4:46
we, unfortunately, got used to these compass customers
4:48
and saw that they did not have follow-up
4:51
of what was going on with their body.
4:53
Became clear that there was a deeper issue
4:55
at play here in terms of systemic disease
4:58
beyond the fracture initially. And so the bigger
5:01
problem was osteoporosis is once we put a
5:03
name and title on that, we began having
5:06
patients not fall through the cracks. So originally,
5:08
where they were, you know, returning to the
5:10
general public and seeing their primary care physicians,
5:12
their OB GYNs, their rheumatologists and endocrinologists,
5:15
you know, no one really truly take control
5:17
of the underlying osteoporosis.
5:19
It was each of their kind of positions
5:21
to handle, but neither or none of them
5:24
really had a central
5:25
indication for their practice. And so these patients
5:27
were falling through the gaps until we generated
5:30
this post fracture clinic, and that is why
5:31
we did this to have a home for
5:33
these patients to turn to after
5:36
their fracture.
5:37
That's great. Thanks so much for sharing. Yeah.
5:39
And so what I'm hearing from both of
5:41
you is that in your respective organizations, you
5:44
really noticed that these,
5:46
patients were falling through the cracks, and we
5:48
hear that time and time again. So kudos
5:50
to both of you for your roles in,
5:52
helping to establish these post fracture care programs
5:54
and clinics.
5:55
And I know that you've both been very
5:57
successful in getting these clinics up and running
5:59
as well. So I'd love to hear a
6:01
little bit about that journey from that
6:03
initial insight that led to kind of starting
6:05
your program to how you're growing and scaling
6:08
today. So, Christina, I'll start with you. If
6:11
you could just share a little bit more
6:12
about how your program has grown.
6:15
So I can't take all the credit for
6:16
the initial drive for it. So our program
6:20
really started back in 2015.
6:22
Two of our EPPs in orthopedic trauma
6:26
took this on and started with a half
6:28
day clinic once a week just addressing
6:31
the low hanging fruit, the hip fragility fractures.
6:34
And it was only coming from our main,
6:37
medical center campus.
6:39
And so it quickly grew, and it was
6:43
headed up by an orthopedic trauma surgeon who
6:47
was a little bit older and not operating
6:49
as much, but he had some experience at
6:52
a prior position
6:54
with a fracture liaison,
6:55
service. And so
6:57
with his guidance, their half day clinic quickly
7:00
grew, and they all realized that they really
7:02
needed a full time person to really
7:06
own it and take it on and expand
7:08
it. So,
7:09
I was doing some joint replacement,
7:12
with one of our, within our department, and,
7:15
I got the opportunity to
7:17
take that full time position in 2017.
7:19
So I have been doing full time bone
7:21
health since 2017
7:24
and, really
7:25
clearly developed a passion for it because I'm
7:27
still here and talking to you guys today.
7:29
But that half a day clinic quickly expanded.
7:33
And by about 2019,
7:35
we,
7:36
had two full time APPs
7:39
and one dedicated
7:41
medical assistant.
7:43
And we were seeing patients out of six
7:45
different clinic locations across Houston. So,
7:48
we were really full steam ahead, doing well,
7:51
and, of course, COVID hit. So, like probably
7:55
most places, things scaled back a little bit.
7:58
And so we we we dropped a few
8:00
locations and kind of had to hunker down
8:02
for a few years. But
8:03
I'm really happy to say that for the
8:05
last two years,
8:07
we've been able to maintain
8:10
two full time APP
8:12
physicians in bone health, and we have another
8:14
nurse practitioner who does one clinic a week
8:18
for just bone health. And so we're across
8:21
four different locations, but we've got seven
8:24
full day clinics going per week,
8:27
and two
8:29
half day telemedicine visits per week. So we've
8:33
really been able to take our our clinic
8:35
from just one location and expand it to
8:38
really reach a large patient base, not just
8:40
from that one hospital, but to the more
8:43
outlined community based hospitals within the Memorial Hermann
8:46
system.
8:48
That's excellent. Wow. What tremendous growth for sure.
8:51
And to weather, you know,
8:54
the growing pains, I'm sure, as well as
8:56
COVID, as you mentioned, it sounds like you
8:58
guys are on a great path and,
9:00
have a a really great opportunity to serve
9:02
a lot of patients.
9:03
Greg, I'd be really curious to hear kinda
9:06
how your,
9:07
clinic is going and how it has kind
9:09
of grown over time as well.
9:11
Yes. Thank you very much. Well, just like
9:13
surviving a fracture is a daunting test, starting
9:15
a clinic such as a bone fracture clinic
9:17
or a post fracture clinic is also quite
9:19
daunting. And so, you know, we had to
9:20
start with what we know and what we
9:22
saw as the original problem. And that was
9:23
the fracture patients that kept recurring within our
9:26
own practice. And so we started as an
9:27
internal post fracture clinic initially, seeing only our
9:30
internal referrals. I work with 18 wonderful wonderful
9:34
colleagues, and so that's a large referral source
9:36
coming from all the trauma centers and all
9:37
the call that we take. And so starting
9:39
off again like Christina said, you know, hip
9:41
fractures, the low hanging fruit, going from there
9:44
to the wrist fractures, to the pelvis fractures,
9:45
to the other fertility fractures, and moving along
9:48
one by one as we grew that clinic
9:50
enabled us to be successful. You don't want
9:52
to take on too much too early because
9:54
you don't want this to fail. Right? We
9:55
want this to be successful and so slowly
9:57
kind of migrating this pathway as we prove
9:59
the processes is key. So yes, after that
10:02
our reach broadened and we significantly started accepting
10:05
patients from external referrals. These would be people
10:07
that were post fracture from other orthopedic clinic
10:10
clinics. These were people from other practices, you
10:12
know, coming from primary care, endocrinology, rheumatology, places
10:16
that might have a long wait. And then
10:17
of course from the hospital systems themselves in
10:19
the area. So, you know, generating
10:21
EMR
10:22
basically,
10:23
identification
10:24
of patients that are high risk or fractures
10:27
that may not be considered fragility fractures, but
10:29
just, you know, could link together a bunch
10:31
of fracture history for those patients. Those are
10:34
how we identified additional patients that would be
10:35
beneficial once we kind of shifted to the
10:37
preventative
10:38
side of things.
10:39
And really that was the biggest shift that
10:41
we had as we we kind of went
10:43
from this post fracture
10:45
recovery
10:46
to prevention on the side of people that
10:48
didn't have fractures yet. And that's where we
10:50
really want to hit this population and and
10:52
be aggressive. And so we are currently still
10:54
seeing about six to 10 new patients a
10:56
week that is growing actively,
10:58
and we look to continue to grow this
10:59
clinic in the right direction as we move
11:01
through the future.
11:03
Excellent.
11:04
Wow. So two really great examples of really
11:07
successful bone clinics treating osteoporosis patients. So again,
11:10
congrats guys. I know this is a lot
11:12
of work. And despite all the successes that
11:14
you've just shared, I am sure that you've
11:16
both run into a bunch of challenges along
11:18
the way. So I think it'd be really
11:19
helpful for our listeners to hear some of
11:22
those challenges and how maybe you address them.
11:24
Christina,
11:25
I can turn it over to you first.
11:28
So one of our biggest struggles being
11:31
not
11:32
connected
11:33
in the same health system with us being
11:35
UT physicians
11:37
and Memorial Hermann being the hospital system
11:40
is bridging the gap between those two systems.
11:44
Unfortunately, we're not even in the same EMR.
11:47
So
11:48
what could just be a couple clicks and
11:50
some what seems like an easy referral just
11:52
has never panned out that way.
11:54
So when I first started,
11:56
in Arbonne Health Clinic, I was doing inpatient
11:59
consults as well as the outpatient clinic. And
12:02
so that was a little bit easier for
12:04
the patients that I saw to than directly
12:06
see me in clinic. But
12:08
as I think most bone health programs grow,
12:11
it became unsustainable
12:13
to have both inpatient and outpatient
12:15
services for one person.
12:17
At the time, we did have kind of
12:19
regular work groups between UT and Memorial Hermann
12:22
providers,
12:23
staff, some of the administrative partners,
12:26
and they were focused on bone health.
12:29
It it became
12:30
more about the metrics you see around inpatient
12:34
issues, such as length of hospital stay, time
12:37
to the OR,
12:38
all cause readmissions,
12:40
instead of address, addressing directly how do we
12:43
get these fracture patients
12:45
to a bone health clinic so that they
12:47
don't come back to see us again.
12:49
And so that program
12:52
kind of disbanded again with COVID.
12:54
I am optimistic
12:56
with, one of our nurse practitioners that's doing
12:59
bone health. She also has an inpatient presence
13:03
as well,
13:04
and she is kind of regathering the troops,
13:07
with some of our interested hospitalist partners
13:10
to refocus both the UT and the Memorial
13:13
Hermann sides
13:14
on how can we really get that connection,
13:18
cross between inpatient and outpatient.
13:21
And we have a few more interests from
13:23
our specialists like the endocrinologist and our geriatricians
13:26
too. So I'm really hopeful that,
13:29
bringing everyone back together,
13:31
we are now on a similar medical record
13:34
system, not the same, but similar. So I'm
13:37
hoping that we can all put our heads
13:39
together and maybe do a better job about
13:41
bridging that gap now that we have more
13:43
parties from from different departments working together.
13:47
Great. Yeah. It sounds like that's
13:49
pretty complicated for a lot of reasons to
13:52
coordinate that patient
13:54
care across the continuum, especially with so many
13:56
different parties involved in different,
13:59
sites of care. So sounds like you're well
14:01
on your way. Doctor. Mines, same question to
14:04
you. What kind of challenges have you guys
14:05
faced and how are you addressing them today?
14:08
Yes. Thank you. So I think we have
14:10
a great, referral source right now, but unfortunately,
14:12
we're still targeting and and most of our
14:14
patients are post fracture. And so we're really
14:16
trying to address this and and shift into
14:19
that preventative care and really attack the patients
14:21
that are very high risk pre fracture.
14:23
With that being said, we're working on addressing
14:26
the workflows particularly our referral network beyond our
14:29
practice coming from the inpatient hospital systems, the
14:31
outpatient hospital systems, and the other orthopedic and
14:34
primary care and private specialties in the area.
14:38
Additionally, on a personal level, we've had some
14:40
staffing issues in our clinic.
14:42
Originally had an APP working very closely with
14:45
me, at some of the other office locations,
14:47
seeing some of these patients with me. But
14:49
since then, she's moved on for personal reasons.
14:51
And so really our hope is to hire
14:53
another either full time physician or another APP
14:56
that could take on the challenge as the
14:57
response for this bone health clinic has been
14:59
overwhelmingly great, but at the same time, it's
15:02
taking over our practice in a way like
15:04
we didn't imagine. And so with the amount
15:06
of people out there that need the help
15:08
and the care that we are providing, I
15:10
do expect it to continue to snowball and
15:11
grow, which is an excellent thing for both
15:13
us and the patients. But at the same
15:15
time, we need to find someone dedicated and
15:16
who could be that champion alongside of me.
15:19
Yep. That makes sense. Well,
15:22
this is really helpful, guys. I think that,
15:24
you've both shown that you can make really
15:27
great progress in in terms of getting these
15:29
clinics started and increasing the number of patients
15:32
that you're able to see. So, again,
15:34
congrats to you and your respective programs.
15:36
I think that our listeners would really love
15:38
to hear just advice that you have for
15:41
somebody out there that would be considering taking
15:43
a sim a similar journey as you just
15:45
described from kind of the initial realization that
15:49
this is a problem to getting a a
15:51
program up and started and and growing that
15:54
program through all the hurdles and barriers.
15:56
Doctor Mines, I'll start with you. What advice
15:59
would you have for our listeners that are
16:00
looking to develop their passion in bone health
16:02
just like you guys have?
16:04
Well, I'd say the first thing is that
16:06
make sure your team and yourself have the
16:08
passion and dedication and the time to undergo
16:10
something like this. So, you know, in my
16:12
experience that, like we mentioned earlier in this
16:14
podcast that, you know, there's a lot of
16:16
different specialties that could take control of the
16:18
situation. You have endocrinology, rheumatology, orthopedics, OB GYN,
16:22
family medicine, and the list goes on to
16:24
even more that could all take control and
16:27
provide the necessary care that's needed for low
16:29
bone mineral density and osteoporosis.
16:31
But at the same time, it requires them
16:33
to push aside time specifically and dedicate time
16:36
to go through that process as we know
16:38
education is power. And by educating our patients,
16:40
they take control of their health as well
16:42
which can lead to optimal goals for everybody.
16:44
And so that requires education to the patient
16:47
in order to get that done and ensure
16:49
success. That requires time in the clinic set
16:52
aside to discuss osteoporosis and when there's a
16:54
lot of other
16:55
diagnoses and problems to discuss that can be
16:58
overlooked.
16:59
And so with that, we need to curate
17:01
a team that sets aside that time for
17:03
the patient, creates that time for the patient,
17:05
and also has the passion
17:07
to
17:08
fulfill the knowledge and impart that knowledge upon
17:11
the patient and take ownership of that health
17:14
condition.
17:14
Lastly, the workflow. You know, it's very important
17:17
to have a very solid workflow starting all
17:20
the way from the front desk through your
17:22
authorizations department because this is a difficult field
17:25
to manage in terms of you are working
17:27
with medications that can be quite pricey but
17:29
very useful. And so with that, you don't
17:32
wanna shoot yourself in the foot. We wanna
17:34
make sure that the patient has access to
17:35
the care they need and we're documenting appropriately.
17:38
So ensuring that the front desk is getting
17:40
the right information, your MAs are obtaining the
17:42
right information to identify those high risk patients,
17:45
ensuring that you're having the right conversation with
17:47
the patient. And then on the back end,
17:48
the authorizations department is doing what they need
17:50
to do to be successful.
17:52
It is key to have the proper positions
17:55
in place, the proper people in place to
17:57
really make this workflow and this clinic successful.
18:01
Great. Thanks for that. Christina, any advice for
18:04
our listeners on starting a post fracture bone
18:06
clinic?
18:08
Well, I completely agree with doctor Mines. You
18:10
do need to have, a person and a
18:12
team, really, that is passionate about making it
18:14
happen because
18:16
I always kind of compare it to starting
18:18
your own business, which a lot of us
18:21
come from, you know, medical schools where you've
18:24
kind of got this big network going on
18:26
and things just kind of already seem to
18:28
be in place.
18:30
And so if you're trying to start off
18:32
basically your own service line, but trying to
18:35
start your own business in a way, you
18:37
really are building it from the ground up,
18:39
and you have to go out there and
18:41
essentially market yourself.
18:43
You're you're marketing yourself to the other providers,
18:46
to the other service line that's out there,
18:49
to the,
18:51
nurse navigators, to the medical assistants, kind of
18:53
every person that might be part of this,
18:56
you have to know that you're gonna be
18:59
putting in significant,
19:01
you know, nonclinical,
19:02
non billable,
19:04
face to face time
19:05
with this stuff, especially in the front end
19:07
of it to kind of get those workflows
19:09
up and going.
19:10
And then I also think it's important that
19:13
you circle back on those things too. For
19:15
us, we've got new providers joining. People are
19:18
shifting around to which clinics they're at. And,
19:21
you kinda have to remind people that, hey.
19:22
We're still here. And guess what? We just
19:24
opened a clinic at this location too. So
19:27
it's it's always
19:28
reintroducing
19:29
yourself,
19:30
and that's not something that when I was
19:32
part of just general orthopedic surgery,
19:35
that I necessarily had to do. It was
19:36
kind of already in place. So it's getting
19:39
someone passionate that can help grow it. And
19:42
I think those connections that you make between
19:45
hospital, outpatient, the other providers,
19:47
that's really what's going to
19:49
propel your fracture service, your fracture liaison service
19:54
forward.
19:55
I also think, at least in our area,
19:57
that you have to make connections with infusion
20:00
centers. And, you know, how are you going
20:02
to actually get patients these treatments like doctor
20:05
Mines was saying? Because I think we all
20:07
wish it was as easy as they can
20:09
start it tomorrow, but,
20:11
it takes a little bit more work than
20:12
that, and you have to kind of know
20:14
all the ins and outs. So you need
20:15
those partners and those connections, especially within your
20:18
community, to really make it happen.
20:20
Great.
20:21
I love how you describe the the entrepreneurial
20:24
spirit,
20:25
and I can tell you've certainly embraced that,
20:28
both of you. So, hey, thank you very
20:30
much again to both of you.
20:32
It's really energizing to hear about all of
20:35
the,
20:36
progress that you are making with within your
20:39
own organizations,
20:40
to establish post fracture care programs and bone
20:44
health clinics across different practice settings,
20:46
especially through the orthopedic perspective.
20:49
So I know that our listeners are gonna
20:51
find your experiences very valuable as they consider,
20:53
you know, making that first step forward themselves.
20:56
As for us at Amgen,
20:58
we appreciate, you know, all of
21:01
the interaction with folks like yourselves and for
21:03
our listeners. If you are interested in learning
21:06
more about post fracture care osteoporosis
21:09
population health management,
21:10
please visit our website at fracturecaregap.com
21:13
for more tools, resources, and insights like we're
21:16
sharing here today. Thanks to you both. Thank
21:18
you. Thank you for having me. Thank you,
21:21
Kristen, miss Yazdani, and doctor Mainz for such
21:24
a great discussion on adapting post post fracture
21:26
care programs across practice settings. It's so great
21:28
to have you. This episode is part of
21:31
a four part series on post fracture osteoporosis
21:34
care sponsored by Amgen. You can find the
21:37
full series and additional Becker's Healthcare podcast
21:40
at wwwbeckerspodcast.com.
21:43
This podcast was sponsored by Amgen. Participants were
21:47
compensated for their time by Amgen.