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INDIANAORTHOPAEDICHOSPITAL2012OUTCOMES

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Dear Colleagues,

In 2011 and 2012, a new era in healthcare began with CMS driven challenges in the areas of cost management, quality patient care and information transparency.

Owned and operated by OrthoIndy physicians, the Indiana Orthopaedic Hospital (IOH) was already positioned to face many of these challenges because of its dedication to clinical excellence and ongoing programs monitoring quality, cost and patient satisfaction. Active participation in HCAHPS, Press Ganey and Care Chex has provided valuable insight into areas of successful management and areas for improvement.

Cost containment is an area of great concern to both providers and payers in today’s healthcare environment. In addition to ongoing cost analysis and comparison, IOH supports a new technology committee comprised of active surgeons, administrators and operating room supply and clinical staff that meet monthly to review requests for new technology for the operating room, as well as examine the costs of implants and develop strategies for better cost management.

The quality of patient care at IOH has been actively and aggressively monitored since our first patient was treated in March 2005. In addition to monitoring the quality indicators required by CMS, each department at IOH maintains quality indicators that are measurable and reported each quarter. These departmental goals provide extra efforts that keep IOH at the forefront of clinical excellence.

Because IOH has been dedicated to electronic medical record filing since its inception, IOH has six years worth of reportable data and outcomes platforms. This data can be used to identify areas for process innovation, as well as potential areas for research. Our results continue to demonstrate the quality and efficiency that come from a singular focus on orthopaedic medicine. Furthermore, the commitment of the staff to the mission of IOH, its patients and physicians is the backbone of the remarkable efficiencies in patient care that create quality outcomes.

As healthcare continues to be ‘pushed’ to it’s limits, you will continue to find safe, quality patient care and healthcare efficiency at IOH.2

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Patient Experience at IOH ............................................................................................................................................4Awards 2012 .................................................................................................................................................................5Provider and Facility Information .................................................................................................................................62012 Procedure Volumes ..............................................................................................................................................8National Comparative Reporting ................................................................................................................................12 Safety (SCIP) ........................................................................................................................................................12 Patient Satisfaction (HCAHPS) ............................................................................................................................13 Clinical Outcomes ................................................................................................................................................14 Surgical site infections (SSI’s) ........................................................................................................................14 Length of Stay .................................................................................................................................................14 Mortality Rate .................................................................................................................................................14 Total Joint ........................................................................................................................................................15 Spine ...............................................................................................................................................................16 Outpatient ........................................................................................................................................................17Community Commitment ...........................................................................................................................................18Research and Education ..............................................................................................................................................19 Cartilage Restoration Center (CRC) .....................................................................................................................19 Orthopaedic Research Foundation (ORF) ............................................................................................................19 Fellowships ...........................................................................................................................................................19 Publications ...........................................................................................................................................................20

Table of Contents

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Patient ExperienceI promise to ‘leave my mark’ by creating a patient experience unlike any other in Indiana. I strive to create the best experience for each patient I serve. I am committed to compassion, excellence, patient satisfaction and outcomes. I will always be an advocate for our patients’ rights, safety and health. I am proud to be an OrthoIndy and IOH employee.

- OrthoIndy and IOH’s Patient Commitment

Satisfied Patients

“You want to feel safe, you want to feel like you are going to be taken care of when you come into a place and you want to feel like you’re doing it with the right people. I felt comfortable and welcome at OrthoIndy.” - Ronald Nored

“I had a great experience at OrthoIndy and IOH. My physician was very professional and explained everything to me. He is very knowledgeable and was able to explain everything to me in a way that made sense.” - Chuck Benslay

“My experience at OrthoIndy was great. The doctors were very nice and took good care of me. I really liked my physician. He asked for my opinion about my knee and the surgery, not just my parents. I also liked that he was confident he could fix the problem I had.” - Eli Brown

“My experience with IOH and Outpatient Physical Therapy has been nothing short of the best. As much as I have a will and desire to get better, they have a will and desire to make and help me get better as well. They truly care and love their patients. My physician and his assistant have been extremely attentive to my needs, encourage me to ask questions and participate in their care and treatment. They have become my biggest cheerleaders and even life-long friends.” - Melissa Burns

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AwardsPress Ganey IOH has been the proud recipient of the Summit Award for the past four years in a row.

Press Ganey currently partners with more than 10,000 health care facilities — including 50 percent of all U.S. hospitals — to measure and improve the quality of their care. The Press Ganey Summit Award is the health care performance improvement industry’s most coveted symbol of achievement bestowed annually. Recipients of the award set themselves apart from the competition by demonstrating their dedication to improvement and sustaining excellence in both quality of care and patient satisfaction.

According to Jane Keller, Chief Executive Officer at IOH, the award represents important recognition within the industry of our efforts. “We are honored to receive this award for the fourth year in a row,” said Keller. “Since opening in 2005, our physicians and staff are committed to providing the highest level of customer service and patient satisfaction that this award demonstrates; a physician-owned hospital model that provides the best outcomes, safety and high quality customer service to each patient and their family member.”

Becker’s Spine Review 57 Sports Medicine Practices to Know (OrthoIndy)

Carechex 2012 Ratings include: • #1 in the State for Major Orthopaedic Surgery for Patient Safety • #1 in the State for Overall Hospital Care for Patient Safety • #1 in the State for Overall Surgical Care for Patient Safety • #1 in the State for Joint Replacement Surgery for Patient Safety • Top 10 percent in the Nation for Major Orthopaedic Surgery for Patient Satisfaction • Top 10 percent in the Nation for Overall Hospital Care for Patient Satisfaction • Top 10 percent in the Nation for Overall Surgical Care for Patient Satisfaction • Top 10 percent in the Nation for Joint Replacement Surgery for Patient Safety • Top 10 percent in the Nation for Spinal Fusion for Patient Safety • Top 10 percent in the Nation for Spinal Surgery for Patient Safety

Industry RatingsIn 2012, IOH was designated by Aetna as an Institute of Quality (IOQ) for Total Joint Care and for Spine Care

Top Work PlaceIOH received the Top Work Place award from the Indianapolis Star for 2010, 2011 and 2012. The evaluation is based on feedback from employee surveys.

Women Certified®

Recognized as one of the country’s Top 100 Hospitals for Patient Experience based on female patient satisfaction in 2011 and 2012.

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Our TeamCare Providers • 48 Board Certified Orthopaedic Surgeons • 11 Pain Management Interventionalists • 8 Physiatrists • 2 Anesthesia Pain Specialists • 1 Primary Care Pain Specialist • 13 Anesthesiologists • 36 Physician Extenders (NP and PA) • On site Hospitalist Staff 24/7

Surgeon Providers by Specialty • 1 Bone Tumor and Soft Tissue Oncology • 3 Cartilage Restoration • 5 Foot and Ankle • 14 General Orthopaedics • 5 Hand and Upper Extremities • 12 Hip • 22 Knee • 4 Pediatric Orthopaedics • 18 Shoulder • 5 Spine • 22 Sports Medicine • 10 Total Joint - Hip and Knee • 10 Trauma

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Our FacilitiesIndiana Orthopaedic Hospital (IOH) • 3 facilities (Main, South and West) • 38 inpatient beds • 16 state-of-the-art operating rooms • 4 procedure rooms • 3 MRI’s and 1 CAT scan • 5 outpatient physical therapy locations • Inpatient physical therapy (main) • Integrated EMR since 2006

OrthoIndy • 11 practice locations • 200,000 patient visits per year • Fully digital practice and EMR systems • 3 professionally staffed Walk-In Clinics

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Procedure VolumesIOH Activity 2012 • 12,051 surgical cases • 5,978 outpatient pain procedures • 9,443 inpatient PT visits • 49,000 outpatient PT visits • 6,602 MRI scans (3 sites - Main, South, West)

IOH Top Procedures 2012 • 3,911 arthroscopic procedures (knee, shoulder, ankle, wrist, elbow, hip) • 1,693 joint replacements (knee, hip, shoulder, ankle) • 1,635 foot or ankle • 1,593 hand, wrist, elbow • 647 trauma-related procedures • 619 complex spine

IOH Top Admitting Diagnoses 2012 • 1,411 arthritis – hip or knee • 988 knee meniscus (medial) • 757 rotator cuff injury • 639 cervical spine • 504 carpal tunnel syndrome

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Over 2,200 knee arthroscopies in 2012 • Sports injuries • Work injuries • Wear and tear changes in the knee • Knee cap problems

More than 1,300 arthroscopic shoulder surgeries in 2012 • Rotator cuff repair • Ligament reconstruction • Cartilage repairs • Instability corrections • Fracture care

100+ hip arthroscopies in 2012 • Injuries to cartilage • Wear and tear changes in the hip • Ligament damage in the hip

Arthroscopy

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Over 1,100 complex spine surgeries in 2012 • Microscopic spine procedures • Selected outpatient fusion procedures • Inpatient fusion with hardware • Disc replacement procedures

More than 900 knee replacement surgeries in 2012 • Degenerative arthritis (wear and tear) • Osteoarthritis (hereditary) • Rheumatoid arthritis • Post trauma joint damage

456 hip replacements in 2012 • Degenerative arthritis • Osteoarthritis • Rheumatoid arthritis • Joint deformities

Spine & Joint

In 2012, IOH was designated by Aetna as an Institute of Quality for Total Joint Care.

In 2012, IOH was designated by Aetna as an Institute of Quality for Spine Care.

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Over 1,500 basic to complex hand care procedures in 2012 • Carpal tunnel • Trigger finger • Nerve entrapment • Fracture care • Wrist and elbow procedures

More than 1,600 comprehensive foot and ankle care procedures in 2012 • Ankle arthroscopy • Correction bony deformities • Ligament and tendon repair • Fracture care • Fusion or replacement of painful joints

Follow up trauma care • Ongoing fracture care • Hardware removal • Joint reconstruction • Muscle and tendon repair

Hand, Foot, Ankle & Trauma

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SCIP (Surgical Care Improvement Project)

SCIP is a national quality partnership of organizations focused on reducing the incidence of surgical complications. The SCIP program is sponsored by the Centers for Medicare and Medicaid Services (CMS).

The SCIP monitoring program reports on the following hospital activities: • Giving the right antibiotic at the right time before surgery • Using proper technique to prep the surgical area • Making sure the patients’ other medical issues are properly managed • Using the best methods to prevent blood clots • Making sure patients’ temperatures are properly maintained to promote good wound environment

Hospital 2012 SCIP - Rate 2012 National Ranking (percentile)

Indiana Orthopaedic Hospital LLC., Indianapolis 99% 94th

Orthopaedic Specialty (1), Fort Wayne 99% 80th

Orthopaedic Specialty (2), Fort Wayne 100% 97th

Orthopaedic Specialty, Morgan County 99% 85th

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HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)

National, standardized, publicly reported survey of patients’ perspectives of hospital care. • Communication • Environment • Pain control • Receiving help • Hospital rating • Education

Patients who reported: IOH Hospital AMarion County

Hospital BHamilton County

State (Indiana)Average

NationalAverage

Their nurses “Always” communicated well 89% 75% 83% 80% 78%Their doctors “Always” communicated well 87% 81% 83% 82% 81%

They “Always” received help as soon as they wanted 84% 58% 69% 70% 67%

Their pain was “Always” well controlled 79% 68% 77% 72% 71%Staff “Always” explained about

medicines before giving it to them 74% 59% 66% 64% 63%

Their room and bathroom were “Always” clean 90% 62% 81% 76% 73%

The area around their room was “Always” quiet at night 80% 55% 63% 60% 60%

YES, they were given information about what to do during their recovery at home 92% 84% 90% 86% 84%

YES, they would definitely recommend the hospital 92% 78% 88% 73% 71%

Patients who gave their hospital a rating of 9 or 10 on a scale from

0 (lowest) to 10 (highest)90% 74% 85% 74% 70%

CMS.Gov website 2013

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Clinical OutcomesSurgical Site Infections (SSI’s) • Orthopaedic SSI’s prolong total hospital stays by a median of two weeks per patient • Approximately double rehospitalization rates • Increase healthcare costs by more than 300% • Patients with orthopaedic SSI’s have substantially greater physical limitations and significant reductions in their health-related quality of life *

Length of Stay (Days) Mortality Rate

IOHPublished National Average1

All Surgeries .45% 0.807-0.848%Joint

Replacement 0.87% 0.813-0.944%

1 2011 CDC Report on National Standardized Infection Ratios using HAI data from all NHSN facilities

*The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost.Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. Infect Control Hosp Epidemiol. 2002 Apr;23(4):183-9

IOH Published Average

Total Knees 2.6 3.1Total Hips 2.4 3.9

Lumbar Fushion 2.85 3.9Cervical Fusion 1.1 2.7

IOH Published Average

Total Knees 0% .09%Total Hips 0% .19%

Lumbar Fushion 0% .12%Cervical Fusion 0% .31%

15*References available on request

Total Joint Program • In 2007 we began monitoring outcomes for lower extremity joint arthroplasty procedures through a database that follows patients for up to six months post-operation. • In 2011, we began submitting data to the American Joint Replacement Registry. • In 2012, IOH was designated by Aetna as an Institute of Quality for Total Joint Care. • Successful Care Strategies: • 87% attended joint replacement education class • 93% evaluated by Hospitalist prior to surgery • 61 minutes-average time for knee replacement • 54 minutes-average time for hip replacement • 84% discharged to home • 96% had peripheral nerve blocks before surgery for pain management

Procedure Case VolumeAverage Length of Stay

Revision Rate Infection Rate Hospital Mortality Rate

30 Day Readmission

(all causes)

IOH Knee Replacement 965 2.64 (totals)

1.89 (uni’s) 0.8% 0.36% 0% 1.5%

Published Averages for Total Knee*

Reference Population

>4,0003.1 days 1-2% 0.4% 0.09% 5.3%

IOH Hip Replacement 464 2.4 days 1.1% 0.65% 0% 2.2%

Published Averages

for Hip Replacement*

Reference Population

>4,0003.9 days 1-2% 0.6% 0.19% 5.3%

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Multi Disciplinary Spine Care • Non operative spine specialists provide comprehensive treatment modalities • Therapeutic exercise, PT, traction • Ongoing pain management plans • TENS or other similar devices • Injections (facet, epidural, trigger point) for treatment or diagnosis • Comprehensive diagnostic capabilities • MRI, CT scans, EMG’s, nerve conduction studies • Hospitalist based smoking cessation strategies • Walk-In Clinic spine specialist • Microscopic and open spine procedures • In 2012 IOH was designated by Aetna as an Institute of Quality for Spine Care

Procedure Case Volume

Average Length of Stay

Revision Rate

(6 month)

Infection Rate

Hospital Mortality

Rate

30 Day Readmission for Additional

OrthoIOH Lumbar

Fusion 230 2.7 days 2.2% 0.36% 0% 1.7%

Published Average for

Lumbar Fusion*N>15,000 3.91 days 4.9% 0.4% 0.12% 3.8%

IOH Cervical Fusion 250 1.1 days 1.1% 0% 0% 0.8%

Published Average

for Cervical Fusion*

N>15,000 2.71 days 2.1% (2 year) 4.9% 0.31% 3.8%

*References available on request

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Outpatient Surgical Procedures • Comprehensive orthopaedic procedure capabilities • All joints • Sports medicine • Selected spine procedures • Worker’s comp • Minor trauma • Selected joint resurfacing procedures (knee or shoulder) • Monitored quality care measures*

• Efficient scheduling processes • Patient Follow up

*Summary: Surgical Care Improvement Project (SCIP) Out-patient

Infection Prevention Measures Overall Rating of Care by Patients

Likelihood of Recommending IOHRating of Care Provider

2012 IOH NationOP-6 99.5% 96.9%OP-7 100% 97.1%

100% 2011 (N=1,922) 2012 (N=2,059)

2011 (N=1,913) 2012 (N=2,051)

2011 (N=1,912) 2012 (N=2,055)

100%100%

50%

50% 50%

0%

0% 0%

Very Good

Very Good Very Good

Good

Good Good

Fair

Fair Fair

Poor

Poor Poor

Very Poor

Very Poor Very Poor

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Jingle Bell Run for the Arthritis FoundationThe Jingle Bell Run is the Arthritis Foundation’s annual event that raises funds to fight arthritis, the nation’s leading cause of disability.• In 2012 OrthoIndy, as the local presenter, raised over $15,000 for the Arthritis Foundation.

Operation Walk USA Operation Walk USA is a non-profit medical humanitarian organization that provides free hip or knee replacement surgeries for patients in need.• In 2012 IOH and Dr. David Fisher provided two hip and one knee replacement surgery at no charge to three deserving Indiana residents.

Corporate ChallengeThe ISC Corporate Challenge is a fun-filled community event that emphasizes healthy lifestyles, friendly competition and company camaraderie. • In 2012 OrthoIndy and IOH received first place in the health care division.

Kids Against HungerKids Against Hunger packages highly nutritious, life-saving meals for starving and malnourished children and their families in developing countries and the United States.

Arthritis Walk/Movement MarchThe Arthritis Walk is the Arthritis Foundation’s nationwide event that raises awareness and funds to fight arthritis, the nation’s leading cause of disability.

Community Commitment

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Cartilage Restoration CenterThe Cartilage Center was founded by Dr. Jack Farr, in 1998. It was further developed in conjunction with the Orthopaedic Research Foundation (ORF) and orthopaedic surgeons from OrthoIndy. The Center’s goal is to offer a full range of contemporary options for cartilage problems (predominantly at the knee). These options include both the non-operative Cartilage Care Center and the latest repair/restorative procedures through the Cartilage Treatment Center, including arthroscopic and tissue sparing approaches. Sharing information on a regular basis with other centers throughout the world, the Cartilage Center’s surgeons and research assistants are committed to advancing cartilage repair and restoration and are actively participating in new clinical research.

The Orthopaedic Research Foundation, Inc. (ORF) Founded in 1986, the Orthopaedic Research Foundation is an independent, not-for-profit dedicated to the advancement of sci-ence associated with musculoskeletal disorders. The physicians of OrthoIndy partner with the Orthopaedic Research Foundation to support their research and educational interest. The research staff facilitates and supervises both clinical trials and outcome studies. The ORF is instrumental in the preparation of abstracts, manuscripts, grant proposals, scientific posters and presentations, literature searches, local, regional and international conferences, outreach programs and multiple other research activities. In 2012 a learning lab was created at IOH where orthopaedic surgical techniques can be advanced and equipment can be evaluated.

FellowshipsOrthoIndy offers fellowship opportunities in spine, sports medicine and trauma. • Spine – OrthoIndy’s Spine Fellowship is a comprehensive program including cervical, thoracic, lumbar, degenerative and deformity training with a number of clinical and research opportunities. • Sports Medicine – OrthoIndy’s ACGME accredited Sports Medicine Fellowship is the only fellowship of its kind in the state of Indiana. • Trauma – OrthoIndy’s Trauma Fellowship, now at St.Vincent Hospital and OTA accredited, has been training fellows for more than 15 years.

Innovation for the Future

Total Joint Arthroplasty Kolisek FR, Issa K, Harwin SF, Jaggard C, Naziri Q, Mont MA. Orthopaedics. 2013 May;36(5): e633-6Minimum 5-year Follow-up for Primary THA Using a Tapered, Proximally Coated Cementless Stem.

Kolisek FR, Mont MA, Costa CR, Johnson AJ, Jaggard CE Surg Technol Int. 2011 Dec 1; XXI: 194-198A Comparison Study of Two Cruciate-Retaining Total Knee Designs: A Preliminary Report.

Mont MA, Johnson AJ, Naziri Q, Frank Kolisek, MD, Leadbetter WB Journal of Arthroplasty 2011 epub Sep 30.Patellofemoral Arthroplasty 7-year Mean Follow-Up.

David A Fisher, MD, Bernasek TL, Puri RD, Mary Burgess Journal of Arthroplasty Vol. 26 No. 6, 2011 (pp. 877-882).Rotating platform spinouts with cruciate-retaining mobile-bearing knees.

Barrett WP, Mason JB, Maskal JT, Dalury DF, Oliashirazi A, David Fisher, MD Journal of Arthroplasty 2011 Epub Jun 30Comparison of Radiographic Alignment of Imageless Computer-Assisted Surgery vs Conventional Instrumentation in Primary Total Knee Arthroplasty.

Thomas L. Bernasek MD, John A. Polikandriotis PhD, MBA, MPH, Melissa F. Levering BS,David F. Dalury MD, David A. Fisher MD, Michael J. Adler MD The Journal of Arthroplasty 28 (2013) 1231–1234Five- to Ten-Year Outcomes for Modular Metal-On-Metal Total Hip Arthroplasty

Cartilage Restoration Engelhart L, Nelson L, Lewis S, Mordin M, Demuro-Mercon C, Uddin S, McLeod L, Cole B, Farr J. Am J Sports Med. 2012 Oct:40(10): 2264-2272 Sep 7 (epub)Validation of the Knee Injury and Osteoarthritis Outcome Score Subscales for Patients With Articular Cartilage Lesions of the Knee.

Cook JL, Farr J. J Knee Surg. 2012 May; 25(2):83 Cartilage repair in the knee: part III. Foreword.

Farr J, Covell DJ, Lattermann C. Sports Med Arthrosc. 2012 Sep;20(3):181-186Cartilage lesions in patellofemoral dislocations: incidents/locations/when to treat.

Cole BJ, Deberardino T, Brewster R, Farr J, Levine DW, Nissen C, Roaf P, Zaslav K.Am J Sports Med. 2012 Sep;40(9):2015-2022Outcomes of Autologous Chondrocyte Implan-tation in Study of the Treatment of Articular Repair (STAR) Patients With Osteochondritis Dissecans.

Farr J, Cole BJ, Sherman S, Karas V. J Knee Surg. 2012 Mar;25(1):23-29Particulated articular cartilage: CAIS and DeNovo NT.

Farr J, Cook JL. J Knee Surg. 2012 Mar;25(1):1Cartilage repair in the knee: part II.

Cole BJ, Jack Farr, MD, Winalski CS, Hosea T, Richmond J, Mandelbaum, De Deyne PG American Journal of Sports Medicine Vol. 39 No. 6, 2011 (pp.1170-1179). Outcomes after a single-stage procedure for cell-based cartilage repair: a prospective clinical safety trial with 2-year follow-up.

Jack Farr, MD, Cole B, Dhawan A, Kercher J, Sherman S Clinical Orthopaedics and Related Research Vol. 469 No. 10, 2011 (pp.2696-2705).Clinical cartilage restoration: evolution and overview.

Spine Trammell TR, Flint K, Ramsey CJ. J BoneJoint Surg Am, 94-A(16): August 15, 2012A Comparison of MRI and CT Imaging Clarity of Titanium Alloy and Titanium Alloy with Coblat-Chromium-Alloy Pedicle Screw and Rod Implants in the Lumbar Spine.

Orthopedic Oncology Rougraff BT, Lawrence J, Davis K Clinical Orthopaedics and Related Research. 2012 Mar;470(3): 706-711Length of Symptoms Before Referral: Prognostic Variable for High-Grade Soft Tissue Sarcoma?

Outcomes Instruments Farr J, Verma N, Cole BJ. J Knee Surg. 2013 May 31 (Epub)Validation Study of an Electronic Method of Condensed Outcomes Tools Reporting in Orthopaedics.

Engelhart L, Nelson L, Lewis S, Mordin M, Demuro-Mercon C, Uddin S, McLeod L, Cole B, Farr J. Am J Sports Med. 2012 Oct:40(10): 2264-2272 Sep 7 (epub)Validation of the Knee Injury and Osteoarthritis Outcome Score Subscales for Patients With Articular Cartilage Lesions of the Knee.

Nicholas J Greco, MD; Allen F Anderson, MD; Barton J Mann, PhD; Brian J Cole, MD, MBA; Jack Farr, MD; Carl W Nissen, MD; and James J Irrgang, PT, PhD, ATC, FAPTA. American Journal of Sports Medicine Vol. 38 No. 5, 2010 (pp. 891-902)Responsiveness of the International Knee Documentation Committee Subjective Knee Form in Comparison to the Western Ontario and MacMaster Universities Osteoarthritis Index, Modified Cincinnati Knee Rating System, and Short Form 36 in Patients with Focal Articular Cartilage Defects.

Publications

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