Illinois Joint & Bone Institute: David Wold, Chief Operating Officer

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In Lake County, Illinois, near Chicago, the first total ankle replacement surgery took place in the fall of 2008. This new ankle, which is anatomically similar to a real ankle and preserves a significant amount of natural bone, moves and works much like a “normal” ankle. It was only one of thousands of successful joint replacements performed by orthopaedic surgeons of the Illinois Joint & Bone Institute (IJBI) last year.

According to David Wold, Chief Operating Officer of IJBI, people tend to be more physically active these days and expect to maintain those activity levels well into their senior years. This activity paired with improved technologies and methods of restoring and replacing joints makes orthopaedic specialization both timely and practical. It has only been little more than a decade that the organization has been built through a series of individual practice mergers.

With locations dotting the heart of Chicago and the surrounding metro area, IJBI is a multi-site physician practice that has become the premier provider of orthopaedic and related services in the Midwest. More than 80 orthopaedic specialty surgeons and 150 health professionals provide services at 20 offices and 40 Chicago area hospitals. Member surgeons are selected for their location and expertise. The organization has made a conscious decision to target growing and affluent communities in order to maintain a high patient base. Physicians are given a lot of individualized control and influence over their practice areas, yet have the benefits of being a part of a large, integrated organization that can facilitate the sharing of resources. IBJI physicians have access to a higher level of management and administrative services technology on a lower cost basis than they would on their own.

Customer Satisfaction First

As a whole, the organization provides specialty services that cover the continuum of musculoskeletal health needs; everything from arthritis and chronic injury care, such as sprains and fractures, to joint reconstruction and replacement surgeries. In spite of tough economic times, IBJI has been able to maintain its patient volume. “We really focused this past year on implementing a customer satisfaction plan designed to make it very convenient for our customers to interact with us,” says Wold.

The organization is implementing its first advertising campaign, a combination of radio advertisements and billboards. “We’ve evolved over the years and have an excellent reputation,” says Wold. “Our goal is name recognition – to promote who we are and how we are trusted by our patients.”

Operational Efficiency

By reviewing which services can be taken out of the hospitals and incorporated into physician practices, a foundation is being built where superior services can be offered at lower cost. “We collect data internally to show our peers that we can provide orthopaedic care at a lower cost than our competitors. We do that by having very good surgical outcomes, and our rate of infection is less than average,” says Wold. “Our patient utilization of rehabilitation services is significantly less than average.” These statistics have actually helped the organization negotiate increases in contracts with some payers by showing them that overall the plan is saving money.

Another effort to keep incoming revenue high is an initiative focused on becoming compliant with Medicare’s reporting. The organization has recently added an in-house legal officer and a compliance officer to work with physicians in maintaining compliance procedures. “I’m very proud of what we accomplished from that perspective and, again, we’re sharing the cost of with several physicians. We can talk the talk, as well as walk the walk when it comes to having a really solid compliance claim,” says Wold. “Last month, 85% of our collections were related to services billed the previous 90 days. To me, this is reflective of getting things done on the front end. Your dollars are going to come in quicker. So we’ve seen increased cash flow and a reduction in our accounts receivable as a result of what we are calling our ‘clean claim’ initiative.”

Physicians compliant with Medicare reporting are entitled to receive a one and a half percent bonus and this initiative has paid off according to 2008 year-end data.

Future Efficiencies

Though the organization is growing, Wold says it is a focus on excellence in care and patient outcomes rather than size that has given IBJI the reputation it has today. While the current model is working well, Wold sees room for improvement.

The organization divided into separate business centers, for instance, and Wold sees a future where many of those centers are consolidated. Nine call centers could eventually become one, as an example, and the transcription services could be handled jointly rather than each division doing their own. Electronic medical records systems are currently being evaluated. Wold says they are moving slowly on this, wanting to see how the new presidential administration initiatives will affect requirements and making sure that the software IBJI adopts is suitable with the fast-paced environment.

The group is currently expanding into a new geographic area and Wold is excited by the opportunity. Three of the nine business units will be consolidated in this expansion. “If my vision is successful, it will be a wonderful way to open the next three to five years into more consolidation,” he says. “We’ll eliminate a lot of duplication.”

Wold foresees continued controlled and steady growth for the organization, “but not just being the biggest for the sake of being the biggest.” No matter what the future brings, the core values of IBJI will remain the same– to provide the best in patient service and musculoskeletal health outcomes.

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