Hospital for Special Surgery is a leader in creating quality and value in musculoskeletal care and consistently is ranked among the top hospitals in the world for orthopedics. Louis Shapiro, president and CEO since October 2006, has seen HSS win the Gallup Great Workplace Award twice for most engaged workplaces in the world. He recently talked with H&HN about the hospital’s newly created role of chief value medical officer, why its readmission rates are continually below the national average and how HSS plans to share its knowledge on a global scale.

Why did you decide to create the new role of chief value medical officer?

SHAPIRO: As the health care industry continues to change due to general economic forces, the aging of baby boomers and the rise of technology, there are many catalysts to what is called the volume-to-value trend. What everyone is trying to do, including at the federal level, is to improve quality and access to care, thereby making health care more affordable. Unfortunately, what many organizations have opted for is the notion that bigger is better. We have a slightly different point of view, given our organizational model, that bigger is not necessarily better. Here, bigger is just bigger. Better is better. What drives us is how we become better at what we do regardless of how good we are doing it. We have moved from looking at quality in the hospital to quality over a patient's lifetime, starting with a person's disease, extending to intervention and continuing until the patient is better and stays healthy. That’s our definition of real value. We look at it more holistically. To that end, we added a chief value medical officer to the leadership team, Catherine MacLean, M.D., who will help us continue our journey toward becoming better. She is a rheumatologist by training and among the country’s experts on quality and value.

Can you talk about HSS’s readmission tactics and some of your results?

SHAPIRO: We do approximately 1 percent of all joint replacements in the U.S., more than anyone else, so our readmission rates are low. The reason for that is multifaceted. Our surgeons are well above the volume threshold that suggests high quality. We see the patients in advance. They go through our perioperative medicine program, we learn of their comorbidities and we have disease-oriented specialists. If a diabetic patient needs a joint replacement, we make sure that diabetes is not a complication. You’re evaluated before surgery, cared for by skilled personnel in an organization that’s skilled in what it’s doing. We have people who follow the patients longitudinally to make sure they receive the care they need once they leave here and anticipate problems that may occur. Consequently, they are readmitted less than almost anywhere else. If a patient needs to go to a subacute facility, we have a team that has evaluated the facilities in our network that we believe represent the level of quality to which we're comfortable sending our patients. By doing these things, we can deliver the right care in the right place and achieve the right outcome.

What else is happening at HSS that you’re particularly excited about?

SHAPIRO: HSS is in a unique position to do a couple of things. We continue to demonstrate that an independent organization can deliver the highest-value health care in a single set of conditions better than anyone else in the world. We’re also excited about leveraging our knowledge and sharing it with the world. We’re exploring domestic and global expansion to create this model of care at other locations. We’ve created the HSS Global Innovation Institute, where we identify innovations in life sciences, which include drugs, devices and innovations in care delivery, so the rest of the world can benefit without necessarily needing to come here. We’re also excited about innovations that could change the treatment of patients with rheumatoid arthritis. Other initiatives underway could be revolutionary related to the epidemic associated with back pain and the unnecessary inappropriate care that occurs around the world. Changing how patients with hip and knee osteoarthritis are treated has the potential to be transformative with new devices and technology, including digital health. We’re focused on leveraging the knowledge derived from what we do here and making contributions that will represent incremental change and beyond for the health care field.