Latest / CareTalk: Healthcare. Unfiltered. / Promoting Superior Patient-Centered Hernia Care

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Promoting Superior Patient-Centered Hernia Care · CareTalk: Healthcare. Unfiltered.

• 0:00
  It's true that most people don't speak with their surgeon once their care is over, but I was so impressed by my doctors and their approach to hernia care that I had to invite them on to the podcast.
• 0:09
  So what are they doing at Boston Hernia that's so special?
• 0:11
  And to what extent can this model apply to the whole system?
• 0:20
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• 1:15
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• 1:17
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• 1:23
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• 1:29
  Welcome to Health Biz Briefs.
• 1:30
  I'm David Williams, president of Health Business Group here with Dr.
• 1:33
  Nora Fullington and Dr.
• 1:34
  Michael Reinhorn.
• 1:36
  Mickey and Nora, thanks for joining me.
• 1:38
  Thank you for having us.
• 1:39
  Thank you.
• 1:41
  What's wrong with her in your repair today?
• 1:43
  So...
• 1:43
  Inguinal hernia care is considered a intern level case, an entry level case for most surgical trainees.
• 1:51
  And so they may do it in their first year of training and then never do it again.
• 1:55
  And then they go out and practice and maybe do 50 hernia repairs per year.
• 2:01
  I learned the hard way that I didn't learn how to do a hernia well in my surgical training and had to learn it over 20 year career.
• 2:09
  so much so that I attended multiple courses, went to different states and even different countries to learn the anatomy.
• 2:15
  And so I've become good at it.
• 2:19
  I still learn the anatomy.
• 2:21
  An average general surgeon has the knowledge that I did when I finished my surgical training and that leads to a lot of variability in care, a lot of more potential for complications and higher cost.
• 2:34
  So that sounds like a problem.
• 2:35
  So what's the solution?
• 2:37
  Yeah, I mean, I think first of all, care should be delivered with the patient as the focus, right?
• 2:42
  So a lot of times when patients go to have a hernia repair, they go see a general surgeon and that surgeon offers their approach, right?
• 2:50
  Whether it's robotic or the traditional open surgery.
• 2:53
  And that approach may not be the best approach for that patient, but it is the approach they do most of the time.
• 2:59
  So the first step I think is really improving surgeon education so that surgeons are equipped with a sort of toolkit of all different ways to do hernia surgery, and then tailoring that care to the patient, making sure the patient is getting the best possible outcome from what we've done.
• 3:19
  So, you know, one of the things we find to be really the ideal approach is putting mesh on the inside of the hernia hole and then also getting it there through the least invasive way possible.
• 3:31
  And we've studied outcomes and kind of generated a data set that shows that patients do better with this type of approach when it's the appropriate approach for them.
• 3:41
  So paying attention to quality, making sure patients are getting the right surgery, and then delivering that care in a really efficient patient satisfying package.
• 3:52
  And contrary to popular belief, the least invasive approach does not involve general anesthesia and muscle paralysis.
• 4:00
  actually involves an open incision to get the mesh behind the abdominal wall, leading to the exact same outcome as laparoscopic or robotic, minus the general anesthesia with reduced post-operative pain and reduced opioids.
• 4:13
  So in the majority of patients, that is actually best for them.
• 4:17
  Well, since you're so specialized in hernia, my last question might not be a fair one, but my question is whether the approach that you take with hernias can be generalized throughout the healthcare system and how much so?
• 4:29
  I think so.
• 4:30
  think if you measure quality, improve quality, and you're accountable for your quality, whether you do it through your national societies or your local institution, you can demonstrate the quality of your work.
• 4:43
  And the quality of your work has to do with both the technical skill and the patient experience.
• 4:49
  And so if you've created a product that has better quality, better patient experience, you figure out a way to price it in a transparent way.
• 4:58
  It doesn't matter whether it's an invasive procedure or a primary care doctor, you can package a high value product for an episode of care.
• 5:09
  Well, that's it for the latest Health Biz Brief.
• 5:12
  If you like what you hear, check out my Health Biz Podcast for a full length interview with Dr.
• 5:17
  Reinhorn and Dr.
• 5:17
  Fullington about their lives and careers.
• 5:20
  Well, thank you so much to both of you for joining me today on Health Biz Briefs.