Anthony Vecchione, Senior Health Care Reporter for NJBIZ, interviews Dr. Zabinski.

Terms of engagement

A value-based specialist model drives down costs and improves quality for orthopedic patients

Physicians participating in Horizon BCBSNJ’s Episodes of Care (EOC) program outperformed non-EOC colleagues for the same procedures in outcomes, quality and cost.

The finding is based on an analysis of 2017 data for patients enrolled in Horizon BCBNJ’s EOCs for hip replacement, knee replacement and knee arthroscopy.

EOC is the model used to engage specialists in the Newark-based company’s value-based strategy.

The idea was to drive improved outcomes and patient experience and ultimately reduce the overall cost of care.

Doctors who choose to participate in the program are rewarded for achieving better quality of care, lower costs and a more positive patient experience.

When EOC specialists achieve those triple goals, Horizon shares cost savings that they receive in addition to their fee-for-service reimbursements.

“The idea was to drive improved outcomes and patient experience and ultimately reduce the overall cost of care,” said Lili Brillstein, director of specialty care value based models for Horizon BCBSNJ.

Brillstein said that there has been interest in the program — not only in New Jersey but also all over the country.

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KNEE REPLACEMENT GIVES PATIENTS A PAIN-FREE LIFE

Shore Medical Center:

ADVANCED SPINE AND ORTHOPEDIC INSTITUTE

“Shore Healthy Living” Newsletter

February 13, 2019

Knee replacement surgeries are a daily occurrence for Dr. Stephen Zabinski and his fellow orthopedic surgeons at Shore Orthopaedic University Associates (SOUA) in Somers Point. “Knees are by far the most common of all joints that are replaced,” said Dr. Zabinski who has been performing knee replacement surgery for more than 20 years.  “Knees are also the joint most commonly affected by osteoarthritis. They are also the most subjective to sports injury and most affected by weight. Those factors can wear the knees away.”

Most patients will visit SOUA with complaints of discomfort from osteoarthritis, though there are many forms of arthritis that negatively impact joints and bones. Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative, “wear-and-tear” type of arthritis where the cartilage gradually wears away. It occurs most often in people age 50 and older, but may occur in younger people as well, according to the American Academy of Orthopaedic Surgeons. Dr. Zabinski added that genetics also plays a factor and said people who tend to sit cross-legged as they eat, or kneel often may have significant discomfort in their knee simply because they are putting a lot of additional stress on the knee itself.

For patients like Louis Cullen, who at 80 years of age is still detailing cars and enjoys being outside, the knee pain he was experiencing caused him to seek help with Dr. Zabinski to see about relieving the pain in his knees and getting back to his life and the things he enjoys.

Getting ready for surgery
But the surgeon said there is a lot a patient has to do to be ready so that they optimize their outcome and hasten recovery. Because of the nature of this operation, there are a lot of factors that need to be discussed prior to surgery that will contribute to the patient’s optimum success, according to Dr. Zabinski. “If they have a problem with urinary retention, I direct them to work with their urologist. If they are overweight, they will need to go on a diet and try to lose some weight. And all my patients know, they must be nicotine free for six weeks. Not just cigarettes or cigars but also nicotine patches, gum and over-the-counter nicotine products.” Dr. Zabinski said nicotine limits the micro circulation and inhibits the healing process. “All of my patients must be nicotine free.”

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Hip replacements move to outpatient-style model

Hip and knee replacements have come a long way in Dr. Stephen Zabinski’s career as an orthopedic surgeon.

But one advancement is something unheard of 20 years ago – patients getting hip replacements in an ambulatory surgical center in the morning and returning home early in the afternoon.

This approach avoids possible days-long recoveries in a hospital and rehabilitation center, ultimately making it more cost effective for health care reform, he said.

Zabinski, vice president of Shore Orthopaedic University Associates, has performed these types of surgeries for more than three years and has been doing them at the Jersey Shore Ambulatory Surgical Center in Somers Point for about six months on certain patients.

“It really achieves all the goals we want to provide better care to patients in a safe way that’s more cost effective,” said Zabinski, who is the director of the Division of Orthopedic Surgery at Shore Medical Center and President of the Jersey Shore Ambulatory Surgical Center.

The hip replacements use a “direct anterior approach” that avoids cutting muscles to put the hip implant in, he said.

The procedure still cuts bone and puts in implants, but avoiding slicing muscles gives patients less pain and more mobility at home, he said.

“A lot of these hip patients because you’re staying away from these muscles, you don’t need crutches or a walker, you can just use a cane,” he said.

Knee replacements, likewise, do not cut the quadriceps muscle, but instead involve sliding the muscle over.

Performed outside of the hospital, the surgeries involve several hours of recovery, a physical therapist’s help at the surgical center and usually a return home by 2 p.m.

Visiting nurses and physical therapists then return to the home for about a week before patients can get treatment at outpatient therapy.

Zabinski said this home-based approach is suitable for about 20 percent to 25 percent of patients.

It is not based necessarily on age, but physical health, muscular build, medical history and the ability of patients to get help from loved ones at home, he said.

He said the approach meshes with where healthcare reform in going in the U.S.

“It keeps me on the curve if not slightly ahead of it,” he said.

A recent study by the American Academy of Orthopaedic Surgeons indicates about 2 percent of Americans are living with artificial joints.

The numbers of these surgeries are anticipated to grow significantly over the years. A study in the Journal of Bone and Joint Surgery found increasing total knee replacements strongly tied to obesity trends in the U.S., particularly with younger patients.

 

https://www.pressofatlanticcity.com/wellness/senior_health/hip-replacements-move-to-outpatient-style-model/article_f7de444c-003d-5967-8e98-6628f92ea80c.html

Joint Pain? Consider Stem Cell Therapy


Shore Orthopaedic University Associates
is pleased to offer the latest treatment in
Regenerative Orthopaedic Medicine… Stem Cell Therapy

Stem cells are undifferentiated cells that can differentiate into specialized cells that are capable of playing a role in helping the body repair and rejuvenate itself.   They can change themselves into cells such as chondrocytes capable of cartilage repair, myocytes which are capable of muscle repair, tenocytes which are capable of tendon repair, as well as cells capable of bone and even nerve repair.  Stem cells can come from many different sources in our own bodies including, blood, fat, bone marrow, dental pulp, as well as many other tissues.  Stem cells can also come from sources outside our own bodies including embryonic tissue, amniotic tissue, and umbilical cord blood. At Shore Orthopaedics, Dr. Charles Krome (who has been performing regenerative medicine procedures since 2008) uses stem cells derived from the umbilical cord blood donated from healthy mothers, along with a patient’s own platelet rich plasma, to treat a variety of orthopaedic/sports medicine conditions including osteoarthritis of the knee, hip, shoulder, ankle, etc., rotator cuff tears, tennis elbow and other tendonopathies of the body, plantar fasciitis, meniscal and ligament injuries, as well as many other musculoskeletal conditions.

There is no surgery or invasive procedures done to the patient. No bone marrow aspiration. No liposuction. The cells are ordered direct from a tissue bank which screens the donated cord blood for diseases and the cells come specifically for each patient’s procedure the morning of the stem cell injection.  The cells are thawed and mixed with the patient’s own platelet rich plasma to maximize healing capability, then injected directly into the treatment area.  Most injections are done under ultrasound guidance to ensure appropriate delivery into the joint being treated.  There is no HLA matching which means the cells will not illicit an immune response from the patient.  The potential for healing and improved quality of life is very high with umbilical cord derived stem cells with minimal risks to the patient.

To see if you are a candidate for this exciting regenerative therapy, please schedule a consultation with
Dr. Charles Krome to discuss your therapeutic options.

Appointments available in our Somers Point, Galloway and Cape May Court House offices.

SHOREORTHODOCS.COM
609.927.1991

Cape May County Herald

 

Orthopaedic Surgeon Dr. Greene, Offers Advice on Shoulder Pain

 

Damon A. Greene, MD
Shore Orthopaedic University Associates

Dr. Greene, is an orthopedic surgeon, who is fellowship-trained in sports medicine, arthroscopy and cartilage surgery. He specializes in acute and chronic ligament, tendon and cartilage injuries to all major joints, primarily the shoulders, elbows, knees and hips.

He grew up just outside of Baltimore playing sports such as soccer, baseball and lacrosse. As a result, he suffered from multiple sports injuries, he diligently worked with athletic trainers and became involved with his own physical therapy. From this stemmed his passion for sports medicine.

Dr. Greene attended the University of Maryland and obtained his medical degree from New York Medical College. He completed his orthopedic surgical residency and training at SUNY Downstate in Brooklyn, where he spent an extra year concentrating on the diagnosis and treatment of athletic injuries. He then completed a Sports Medicine Fellowship at the prestigious Ochsner Sports Medicine Institute in New Orleans, where he worked with professional sports teams including the New Orleans Saints and the New Orleans Pelicans.

His love of the outdoors drew him to the Jersey Shore, where he enjoys surfing, sailing and running on the boardwalk. He is excited to become involved with the community and grow roots here. In his downtime, he has started covering Middle Township football games and Stockton basketball games, working with the trainers and coaches to evaluate athletic injuries on the spot.

Dr. Greene offers advice on an issue he frequently treats: Shoulder Pain.

A common cause of shoulder pain is poor posture, especially for those who work in an office. When you sit at a computer and type all day, your shoulders tend to roll forward. If you often get an achy feeling in your back, arms, shoulders or neck, Dr. Greene suggests pinching your shoulder blades once a day for 10 minutes. This will train your shoulder blades where they should be to properly support your shoulders. If you feel numbness or tingling from your neck to your fingertips, the issue could be a nerve root and it’s time to see a doctor.