By Gabrielle White, RN, CASC, Executive Director, Ambulatory Services & Network Development, Hoag Orthopedic Institute

Orthopedics is one of the most promising specialty areas for medical travel. In fact, a growing number of employers are sending employees to Centers of Excellence (COE), provider organizations that specialize in a particular area, delivering better outcomes and cost-efficiency through high volume. Procedures, such as joint replacement, spine surgery, knee and shoulder reconstruction or repair, and hand and feet procedures, performed at COEs have been especially beneficial for patients. At Hoag Orthopedic Institute (HOI) and its subsidiary, Orthopedic Surgery Center of Orange County (OSC), there is a slow and steady stream of patients who travel for surgery — some from as far away as Alaska and, occasionally, from overseas. For HOI and its two surgery centers, OSC and Main Street Specialty Surgery Center (MSSSC), the volume of orthopedic procedures performed in 2012 reached over 10,700, making HOI the largest center for orthopedic care delivery in California. Individuals travel for orthopedic surgery for various reasons, including: Word-of-mouth — referrals and seeing the results of a friend or family member who traveled for care is often enough to convince people to make the trek to a COE that offers a coordinated program and high-performing specialists. Lack of options — If a patient needs to travel distances to receive appropriate care, it makes sense to travel to a COE, which offers high quality at a reasonable cost. COEs are able to offer lower rates because of the high volume they perform for certain procedures. For example, OSC recently performed an ankle procedure on a patient from another part of the US. While the patient was a little apprehensive to be traveling to an unfamiliar environment for surgery, the options provided in the patient’s hometown were limited — and 300 percent more expensive. The patient’s employer paid all expenses for the patient and spouse to travel to Southern California, while still saving on cost compared with local treatment. Self-insured – Self-insured employers, in particular, seek options to reduce their growing healthcare expenditures. Medical travel offers cost-effective care without sacrificing quality, and employees are able to reduce their out-of-pocket costs. Working with the insurance provider, some employers are now seeking COEs for orthopedic procedures, with a focus on quality. Mitigating Expensive Complications  One key contributor to high healthcare costs is post-surgical complications. While complications can occur at any facility and with any specialist, COEs are more likely to deliver the best results. Employers or payers incent patients to travel for care by offering options that produce value: great outcomes and lower overall cost. Educating employees about COEs and engaging them in the process of their own healthcare are two effective strategies for achieving cost-savings through a medical travel program. HOI recently performed a total hip replacement on a young patient from a southern state. Travel expenses for the patient and a companion were covered by the employer. Instead of paying 50 percent out of pocket for the procedure, the patient paid five percent by travelling to HOI, a preferred provider. By relying on preferred provider networks, payers know they are providing access to high-quality care – no matter where the facility is located. Reference Pricing With reference pricing, an employer or insurer makes a defined contribution toward covering the cost of a particular service and the patient pays the remainder. For example, a patient from a neighboring county traveled to Orange County to consult with one of HOI’s top surgeons for joint replacement. The driving force behind the patient’s decision was that HOI is priced within the reference price of the payer, so the patient did not have to pay a difference or overage for the hospital care. At the local hospital, the patient would have had to pay tens of thousands of dollars for the same procedure after the payer covered the reference price. Effective Medical Travel Programs It’s important to find a medical travel program that offers pre- and post-operative care coordination, with secure transfer of patient records. Diagnosis can be done remotely with imaging and reports from providers in the patient’s locale or through the third party administrator. Phone consults are standard, as is a pre-op visit a few days prior to surgery. On their return home, patients are armed with their medical records, reports and instructions from the specialist, hospital and physical therapist for continuation of care. About Gabrielle White, RN, CASC, Executive Director, Ambulatory Services & Network Development, Hoag Orthopedic Institute Gabrielle graduated as a Registered Nurse from Monash University-Gippsland, in Victoria, Australia, in 1989, and moved to California in 1994.  Her career has been focused on Peri Operative Services and Administration. Over the past 11 years, Gabrielle has been the director of Orthopedic Surgery Center of Orange County (OSC), where she oversees clinical and business operations.  OSC is a subsidiary of Hoag Orthopedic Institute (HOI).  In 2008 she formally introduced Travel Medicine to the surgery center and developed the global/bundle-pricing model for OSC and now HOI. Gabrielle’s experience has led to her selection to participate in the Integrated Healthcare Associate’s team for development of a bundled payment pilot model in California. Gabrielle was chosen by Hoag as primary director in the $80M development, construction and start-up of Peri Operative Services for Hoag Orthopedic Institute. Since its opening in late 2010, HOI has become the highest volume orthopedic specialty institute in the Western United States. Gabrielle’s primary role for HOI is executive director of Ambulatory Services and Network Development.