The orthopedic specialty care management team: the McDonald Army Health Center experience

The influx of war injuries taxes the military health care system already hard hit by large numbers of deployed military medical personnel. The purpose of this article is to present the business practices and results of our Orthopedic Specialty Care Management Team program for evaluation and possible replication at sister military treatment facilities who care for "Warriors in Transition". Our program witnessed a 10-week decrease in time until initial orthopedic evaluation and a 16-week decrease in time until initial surgical scheduling. There was a 77.5% increase in surgeries performed (group 1, 129 vs. group 2, 229). The total surgical case load for the orthopedic surgery service increased by 28.3% (group 1, 412 vs. group 2, 529). Our service productivity increased by 76% or 6801 relative value units, although the mean length of stay decreased by 4.1% or 6.9 days. The total cost savings is an estimated $373,766. The program, as modeled, increased access to care for the war-injured soldiers without negatively impacting the usual business practices of the service.