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- [00:00]
A
Welcome everyone to the Becker's Healthcare Podcast. Today's episode explores why health systems should prioritize post fracture care programs. This episode is sponsored by Amgen as a part of a podcast series on post fracture care. And with that, I'll turn the floor over to Amgen's Kristin Buzeman. Hello, everyone. It's a pleasure to be here again today with the Becker's Healthcare Podcast. My name is Kristin Buessman and I am the marketing director for health systems and key accounts for Amgen's bone health franchise in the US And I'm so delighted here to be talking with two of my favorite folks. Folks, we've got Matt Bruns and Jared Torkelson. You guys want to introduce yourself here for our listeners.
- [00:37]
B
I'm Jared Torkelson. I'm a physician assistant with orthopedic surgery and Sports medicine department at Mayo Clinical Health System in Mankato, Minnesota.
- [00:45]
C
I'm Matt Bruns. I'm a certified orthopedic nurse practitioner and clinical densitometrist at SSM Health Orthopedics in St. Louis, Missouri.
- [00:52]
A
Excellent. Thanks, Matt and Jared for joining us today. So today we're gonna have a really great conversation. You guys have both been very involved in establishing post fracture care programs within your respective organizations before details on why leaders should really understand the challenges of osteoporosis management and why post fracture care is a solution to help them manage this patient population. I want to get a little bit more background on the disease state itself, so could you guys kind of share for our audience the challenges that this patient population is facing and the impact that it has on our health systems and on patients?
- [01:28]
C
Yeah, Kristen, I think the answer is simple. The leaders should care about post fracture care because closing these care gaps means fewer fractures for patients and a stronger, more sustainable healthcare system in general. You know, the burden of osteoporotic fractures is Fairly significant. Every 20 seconds in the US a woman over age 55 will suffer an osteoporotic related fracture. And the majority of these women over the age of 50 do not receive formal osteoporosis care. I think that's something we both see in our practices very frequently. You know, 35% of subsequent fractures occur within that first year of the five year follow up after the that initial or sentinel fracture. And that's a pretty significant burden.
- [02:12]
A
Sure is.
- [02:12]
B
Yeah. I know we don't like to talk about money in healthcare, but that's a big part of this too, right? So, you know, by 2040, it's projected that osteoporosis related fracture care is going to cost over 95 million. And I think in the current state of money, we have to find ways to really, you know, garner those resources as best we can and prevent those fractures as well. So post fracture care is in a great position where they can have potential to close that gap, reduce the fractures and also reduce the costs.
- [02:35]
A
Yeah, that makes a lot of sense. Thank you for sharing that background. So, as I mentioned earlier, I know you both have been instrumental in starting post fracture care programs and running them at your organizations. So I'd like to have you both kind of share a little bit about what that looks like. And let's see, we're going to go to Jared first.
- [02:52]
B
Yeah. So I have a bunch of little hats at my shop there, but I work with a busy arthroplasty surgeon part of the time. The other time I run a bone health and fls clinic we've done for the last eight years. We have an infusion center as well where we do a lot of our injections for our patients too. So we try to keep everything under, under one umbrella as you can. We offer a lot of in person and then since COVID to a lot of telehealth options for our patients they really love. And we have a large area, a large rural area, so patients are sometimes having to drive, you know, an hour, two hours to come and see me. So that's been really pivotal, I think in the last couple of years, we took a lot of time beginning to set really dedicated protocols, one for efficiency. And with our patients, but also with our staff too, we respect the patient's time. We want to make sure that they're getting the correct tests. Prior authorizations and appeal processes are another big part that we took a lot of time in the beginning to make sure that those were keen and ready to go. The visits are really thorough and they're thorough because they should be. It's tough because with osteoporosis in the past, no one's really owned it. Right. It's been a primary care issue, it's been orthopedic issue, it's been an endocrinology issue. So trying to take that time with the patient and bring all those things together so they really, you know, we know what's going on with that patient. We're treating them well. We're not missing something along the way. Last year we saw 500 new patients in our bone health clinic. Most of those patients were hip and wrist fractures. We do see some A fair amount of vertebral fractures, and then to a lesser extent, periprosthetic fractures and other fragility fractures too. We are performing some spine optimization. You know, spine care is something that's really pivotal to all of this too. And we're also starting to slowly get into perioperative arthroplasty optimistry in our high risk patients, which is something that's been a big push the last couple years in the bone health world. You know, as we know refracture risk in that first two years after that fracture, roughly 1 in 10 patients are going to refraction that first year. And as that number grows, you can see that first two years after that fracture. It's really pivotal. So we're trying to get those patients as soon as we can. We try to get within six weeks. Usually the first two weeks after that fracture, the patient is trying to get their life back together so we can give that time to settle in and then we want to get them ready to go and get them treated appropriately. So, you know, with our numbers conservative, if we were to save 15 hip fractures, that's roughly 60 hospital bed stays that we've prevented within our hospital. So that's a cost savings. But I'm told too that, you know, you're protecting your margins as well too. So again, we don't like talking about money, but if you can take those beds, one, the patient's in a better position because they never had that fracture, but two, you're saving that for your elective procedures that are going to be more valuable to the hospital system overall.
- [05:16]
A
That's great. Thanks so much, Jared. It sounds like a lot of really great work benefiting patients and really help streamline things at Mayo as well. So, Matt, do you want to tell us a little bit about your post fracture care work?
- [05:28]
C
Yeah, I think that, you know, the unique thing about post fracture care, when we use that, has some variability. And there are several post fracture care models where they talk about the outpatient setting. And our post fracture care program starts as soon as the patient hits the emergency room door with that hip fracture. And I think it's important that inpatient care is streamlined. And so we've worked very diligently to create a system wide program of order sets and care plans that TR to get that patient from the ER to the OR within a 24 hour period. And we have streamlined care plans that then look at trying to reduce delirium and confusion while they're in the hospital to reduce length of stay and so that has a significant impact on their overall care. And then we have care managers and nurse navigators that work with the patients and educate them about their underlying osteoporosis and the importance of addressing that. You know, unfortunately, these audiences when they're there with a hip fracture, are often not receptive to education. And so providing them take home material that they and their family can lean back on to address their upon follow up in the outpatient setting is extremely important. And so educating these patients and raising awareness to them that yes, while this is a bad fracture and we were fortunate enough to get it back together, but here's the long term process of addressing the underlying issues. And so we really, we're focused on education and trying to get these patients to recognize the importance of addressing the underlying osteoporosis issue to prevent these subsequent fractures from happening, which we obviously know are there at high risk for.
- [07:06]
A
That's great. Thanks so much, Matt. So you kind of touched on this a little bit, the issue of how post fracture care programs can really help streamline workflows and processes within the system. I don't know, Jared, would you like to maybe touch on that a little bit more, kind of your perspective on how post fracture care can really care for patients.
- [07:26]
B
So at the end of the day, patient benefits and health system benefits, they're very much intertwined. You know, we've found helpful at Mayo Clinics thinking about that connection between the patient health system. You start with the number of hip fractures we see each year. So the data shows that a good, well running FLS service or bone health clinic can prevent roughly 30% of your refractures. So let's say annually you see 100 hip fractures, so 20, 30 of those patients are avoiding that second fracture, which is fantastic. Another example is if you're practicing performing spine optimization, you're going to revision spine surgery. So you have a patient that maybe at the time of their elective procedure just wasn't optimized, wasn't ready to go, may go on to proximal junction kyphosis or some other thing. You know, a single revision surgery can cost 30 to $40,000 in direct medical costs. So that's just to the patient. You also got to think about, you know, resource allocation. You got to think about the time on the caregiver as well too. So a lot of times if the patient can't take care of themselves or they're going to a swing bed, you can prevent those costs. Also the caregiver costs of having to take time off, having to Travel to help with the patient, getting all those other things. So we can avoid a lot of that with optimizing these patients.
- [08:30]
A
That's great. And Matt, have you guys taken a look at some metrics? Could you tell us a little bit about that?
- [08:38]
C
Yeah. We are in the process of developing a fairly robust dashboard to look at our metrics both in the inpatient setting and in the outpatient setting. We do know that our, through our automatic EMR driven order sets, that we have increased the efficiency, optimized the workflow of getting these patients to follow up. So closing that care gap that exists between the inpatient and the outpatient setting, the current things we have in place, we certainly see the fruit of that. And the Bone Health Clinic with the follow ups, hopefully in the real near future we'll be able to put a number to our successes once the dashboard is up and running.
- [09:17]
A
That's fantastic. Thank you so much. So we've talked a little bit about the importance of post fracture care from both the patient perspective and from the health system perspective. Can you tell me a little bit about, again, how leaders of health systems should think about post fracture care aligning to those goals? Because we know that patients and health system efficiency are obviously big, important goals for health system leaders. So how should we really be thinking about this as a health system executive?
- [09:45]
B
Yeah. So I think, you know, PFC programs naturally complement health systems emphasis on the value based care that we need to provide. And more and more every year, you know, focus on providing the quality outcomes and managing your costs effectively. You know, leaders can strategically align with PFC programs and the broader health initiatives such as chronic disease management and addressing complex patient needs comprehensively. You know, this alignment ensures a holistic approach to the patient care and strengthens your organization's commitment to community health improvement overall.
- [10:12]
C
Yeah, I think that certainly developing a strong tracking and measurement framework is crucial for monitoring the success of these PFC initiatives and identifying areas for improvement. You know, if we can, you know, obtain the data to see where we fall short, I think that that's extremely important to continually improve our processes. But, you know, leveraging our technology and using our EMR when we have the opportunities to utilize telemedicine, I think it's extremely important to facilitate visits for these patients that sometimes struggle to get the outpatient or the clinic setting, I think that's extremely important. And regular program evaluation allows us to assess the effectiveness of the overall program and adapt where we're falling short to meet the needs of the kind of evolving landscape and the goals of our organization in general. But ensuring continuous education and professional development opportunities for staff is also key. Increasing awareness to how these programs can benefit and positively impact patient lives I think is extremely important.
- [11:16]
A
That's great. Thanks so much. So we're here at the Becker CEO CFO Roundtable, where we've got healthcare leaders from all over the nation coming together to learn about how they can continue to improve care at their own organizations. So what would be a piece of advice you have for them and any of our listeners on how to really start thinking about post fracture care and impact implementing post fracture care at their organizations?
- [11:39]
B
Yeah, I think with, with any big project, right, you got to start small. You know, the osteoporosis care gap, it's a big gap. You're not going to solve it in a day or even within a year. So. So start small, build your processes small. I kind of like to think of the faucet analogy, right. So build your faucets beginning and slowly turn them on over time. So start with hip fractures or wrist fractures that are, you know, patients that really need this care and easy to get through. Figure out your pathways, figure out what works, what doesn't, what can your health system do, what can it do? And then slowly expand out from there. I don't know if Matt believes this, but I've never really advertised for my clinic and I'm booked out months. So they will find you. I think osteoporosis is something where historically the people want to do the right thing, but either they didn't get a lot of education on it within their training, or they're just not comfortable and that's okay. So that's where people like Matt and I come in and we're happy to help these patients. You got to measure what you're doing. So I think to show growth and especially to show your executives or your leadership that, hey, we're doing a good thing. Patients are saying that too. With patient satisfaction, you're creating that, that experience for the patient, but also that connection, but also that you're reducing your fracture risk or you're reducing the amount of hospital stays. Those things measuring are very important going forward too.
- [12:46]
A
That's great, Matt.
- [12:47]
C
Yeah, I think you know a lot to Jared's point about starting out small and working your way up. I think that, you know, finding a physician champion or the leader that's going to take this forward is extremely important. You know, don't start from scratch. There are lots of models that have been well documented they successes and you can kind of try and take some cookie cutter things from those and you don't have to reinvent the wheel. But you know, one thing that we found very successful is we designed our program initially with the entire health system in mind, knowing that we may not have all the resources in place in each of our locations to fully provide, you know, a comprehensive bone health program or post fracture care program. But it was designed initially with that in mind so that it could be scalable. So all the order sets when they were initially built were to be implemented system wide, recognizing that as time grows and as we put more emphasis on this area, that we'll find the resources that will continue to fill in over time and we'll have a much more robust program when it's all said and done.
- [13:54]
A
That's great. I want to thank you both so much for sharing your insights today and thank you also for your dedication and commitment to serving this osteoporosis patient population. So I think the work that you're doing in post fracture care and sharing your insights here is going to help a lot of patients and help a lot of health system leaders as they consider how to continue to go forward and really implement post fracture care solutions across their health systems. So thanks so much again guys. Really appreciate it.
- [14:19]
C
Thank you.
- [14:20]
B
Thanks for having us.
- [14:21]
A
Thank you Kristen, Mr. Torkelson and Mr. Bruns for this informative and actionable conversation on implementing post fracture care programs. We also want to thank our podcast sponsor, Amgen. This episode is part of a four part series sponsored by Amgen on post fracture osteoporosis care. You could tune into more podcasts from Becker's Healthcare on post fracture care and other topics by visiting the podcast page at www.beckerspodcast.com.