Jennifer Mitzner is looking to speed up and improve the long-running model of how knee, hip and other types of joint replacement surgeries are carried out in Orange County.
Mitzner is chief executive at Irvine-based Hoag Orthopedic Institute, the state’s largest volume provider of joint replacements for each of the past six years. According to a recent outcome report from the institute, it completed 10,562 surgeries in 2017.
The institute is along Sand Canyon Avenue, and is part of Hoag Memorial Presbyterian Hospital’s expansive campus on the edge of the Spectrum area of Irvine.
The orthopedic institute, a joint venture between Hoag Memorial and a group of the area’s top orthopedic physicians, is a 70-bed hospital with a medical staff of 300 physicians and more than 80 orthopedic specialists.
It ranked No. 15 among area hospitals by revenue last year, with nearly $120 million for the 12-month period ending in September, according to the Business Journal’s February listing. That was down about 7% year-over-year.
The orthopedic institute averages longer stays than most hospitals, which have pushed to grow outpatient volume.
The Business Journal’s list of hospitals reported an average of nearly six outpatient visits for every inpatient stay. By comparison, the orthopedic institute reported about nine times the number in patient stays as outpatient visits.
Super Centers
Mitzner wants to change that ratio. She’s looking to provide patients seeking joint replacements with the ability to be home within a day of their surgery.
She also wants more locations in OC to serve those patients.
The institute is in the planning stages of developing two or more “Super Centers” in the county. Each could run upwards of 35,000 square feet and be built within the next three to five years, she said.
Mitzner said the institute is currently looking at locations in North Orange County and Mission Viejo, in addition to expansion of its existing campus in Irvine.
“We envision if we need to serve all of Orange County, we need three hubs—here [at our main campus in Irvine], and super centers in North and South Orange County,” she said.
Locations would incorporate physician offices, operating rooms, recovery facilities, imaging and physical therapy in one location and provide comprehensive care to include total joint replacement and spine procedures in a 23-hour stay facility.
“At our hospital, our inpatients have an average stay of 1.7 days. However, [Hoag Orthopedic] has been preparing for additional growth in 23-hour [and less] cases,” Mitzner said.
It currently has three ambulatory surgery centers in Mission Viejo, Newport Beach and Orange.
“We envision at least three expansion sites in Orange County in the near future,” she said.
Growing Trend
Hoag Orthopedics’ growth plans follow nationwide developments.
The trend toward total joint replacements at outpatient facilities has exploded in recent years, with more than 200 ambulatory surgery centers performing such procedures in 2017, up from 24 centers in 2014, according to the American College of Surgeons.
The association predicted that 30% of total joint replacements—a procedure whereby a damaged joint is removed and replaced with a prostheses—would be performed in an outpatient setting by next year, rising to more than 50% by 2026.
The shift has been driven by technology, healthcare models pushing for high-quality care at lower cost setting and insurance companies that are more willing to cover outpatient total joint replacements, according to the association.
Studies have shown that patients can achieve good recovery results in their homes, according to the American College of Surgeons.
Mitzner said Hoag Orthopedic is testing an Enhanced Recovery Program that provides patients with a comprehensive screening, education and recovery program to help with post-operative recovery. It’s an outpatient program where patients are not admitted to the hospital but rather recover in a bed or recliner, receive physical therapy and return home on the same day of their procedures.
“It’s a pilot that we will use to expand on for a larger group of patients at our orthopedic super centers,” she said.
Sports Medicine
Since Hoag Orthopedic was formed eight years ago, it has focused on reducing bundled costs for hip and knee surgeries. Now, it wants to expand into sports medicine and physical therapy, also known as musculoskeletal services.
It has made some notable partnerships in that direction. Hoag Orthopedic is the exclusive orthopedic and sports medicine care provider for the Los Angeles Chargers and Orange County Soccer Club.
“We see it as comprehensive care [adding musculoskeletal business], starting with preventative all the way to recovery,” she said. “The next frontier of getting value is to reach into the pre and further into the post.”
Its recent partnership with Costa Mesa-based ProSport Physical Therapy & Performance marks a new foray into the area. As part of the agreement, the orthopedic care provider will be making an equity investment and assuming a board position in ProSport.
ProSport has four physical therapy and performance centers comprised of three 10,000-square-foot physical therapy facilities in Costa Mesa, Laguna Hills and Rancho Santa Margarita, as well as a facility in Rancho Palos Verdes.
Mitzner said the collaboration allowed Hoag Orthopedic to move beyond surgical care and into a hybrid model that drives enhanced clinical and financial alignment.
Mitzner, who said physical therapy is an essential for orthopedic patients, said it is opening a co-branded sports medicine clinic in Tustin.
“In Orange County, we are uniquely positioned to develop a musculoskeletal system of care,” Mitzner said.
Patient Experience
“We are in a consumer business, a highly choice-driven market and everything this organization does is outcome-driven in pursuit of excellence,” said Mitzner, who noted that orthopedic surgery is mostly elective and patients have a choice in where they seek their orthopedic care.
It will roll out a new personalized hospitality program this month “to further improve the overall experience and recovery process to help our patients get back to work, play and life,” she said.
Mitzner took over in 2017 from Dr. Carolos Prietto, a founding partner and practicing orthopedic surgeon at Hoag Orthopedic who was acting interim head.
Previously, she was the chief financial officer of St. Joseph Hoag Health in Irvine. She was involved with the original formation of Hoag Orthopedic.
