PBOI Pioneers Two Groundbreaking Initiatives

by HCE Exchange on December 1, 2014

Brian-Bizub-thumb2Brian Bizub, Chief Executive Officer, Palm Beach Orthopaedic Institute

by Pete Fernbaugh

Brian Bizub has been chief executive officer of Palm Beach Orthopaedic Institute (PBOI) in Palm Beach Garden, Fla., for the past six years after working for Tenet Healthcare in various hospital administrative roles for 12 years.

When he joined PBOI, he brought a gift for customer service and value-added innovation to the physician-practice world.

Implementing a post-surgical DME program

Early on, Bizub and one of his colleagues noticed the lack of consistency throughout PBOI in administering braces to patients following surgery. Certainly, he said, bracing was part of the process, but it was more of an afterthought than the mindset.

However, durable medical equipment is vitally important for post-surgical outcomes, Bizub stressed. He and his colleague began to develop standardized protocols for integrating bracing into the surgical process, first by consulting each of PBOI’s 16 physicians, logging their ICD-9 codes for surgical procedures, and finding out which ones used braces and which ones didn’t, given the different schools of thought on DMEs.

Bizub then created standardized order sets from their research.

To carry out these protocols, he incorporated a DME coordinator into the surgical process. Each coordinator looks at the surgery schedule and selects the appropriate brace based on the surgeon’s protocols for individual patients.

Rather than meeting with the patient days before the surgery to explain the brace, the DME coordinator meets with the patient and the caregiver on the day of surgery as part of the pre-operative process. The coordinator educates the caregiver on how to use the brace and explains to the patient why it is critical to their recovery.

“Usually the patient post-surgery isn’t going to be the person who is going to be dealing with the DME device,” Bizub said. “It’s going to be the caregiver. And you don’t necessarily get that person pre-operatively in the office.”

The brace is then handed over to the recovery unit, where the surgeon can then position it on the patient immediately following surgery. Bizub said it adds value if the patient wakes up with the bracing already on and mobilized. It also increases compliance, a fact that caused hospitals, initially puzzled by the presence of DMEs in the recovery unit, to embrace the protocols.

Since the physicians have implemented these protocols, PBOI has gone from having high DME return rates to virtually no returns at all. Patients have a better understanding of why the brace is important to their treatment and outcome, Bizub said.

“It was difficult to engage the physicians, but they quickly figured out that most patients want to stay in bed, but when you provide them with the security of the brace, they’re more likely to get up. Our goal is decrease pain meds, increase motion, and improve outcomes. And the way that you can do that is by giving the patient a sense of security, because if not, they’re going to sit and watch TV and out of boredom eat, which will have the reverse effect.”

Opening commercial pharmacies in physician group practice offices

Bizub’s second initiative has only been around for approximately five months. The idea behind opening dispensaries in physician offices was initially introduced to him at an American Association of Orthopaedic Executives (AAOE) conference.

Thirty to 40 percent of all patients never go to the pharmacy because it’s time-consuming and takes on average 30 to 45 minutes to have prescriptions filled. Furthermore, most patients end up spending extra money while they wait at a pharmacy. The average spend is $12 per person.

“If you have the patients in the office, it’s part of the visit,” Bizub said. “And they can go to your pharmacy and pay the exact same price as another and be able to take the medication home. However, the patient will always have the choice to fill their prescriptions at their pharmacy of choice. It’s safer because it’s prepackaged, so there are no errors. Education is better because you have a dedicated pharmacy tech who is educating patients on medications and the potential side effects. And because of the strict guidelines of the state and the DEA, it’s important to go through the labels.”

He added PBOI’s dispensary has a failsafe system that requires three scans to ensure the correct medication is being dispensed and recorded.

“Again, we’re not charging anything more,” Bizub said. “We’re adjudicating the claim through their insurance carrier. No different than if they were at a major retail pharmacy, such as Walgreens.”

PBOI does a $10 markup on medication, so patients who lack pharmacy coverage can purchase their medication for only $10 more than the practice paid for it. It’s also more accommodating from a compliance standpoint, he said, because if the patient is participating in a step program, many of the meds may not be on the formulary. Being in the physician’s office enables the conflict to be confronted immediately and resolved almost as quickly.

Finally, patient confidentiality is preserved in a way that might not be possible in a public pharmacy.

The primary challenge is credentialing, since many insurance carriers do not recognize physician dispensaries easily. However, for those practices willing to go through the process, in which an office must have a certain number of denied claims to be seen as a dispensary, the benefits are great. An office dispensary increases revenue and provides a value-added service to patients, Bizub said, and these patients begin to see you as a full-service provider in touch with the entire spectrum of care.

“The more that I can show the customer that they’re important to us and create a relationship, the better the organization will become and the larger it will grow, because PBOI has a reputation in the community for helping patients and providing value-added services that make it convenient and easy for them. PBOI has taken out the challenges that frustrate patients who are dealing with pain. We make the experience less difficult.”

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