Editors’ Note

Louis Shapiro assumed his current position in October 2006. Prior to this, he served as Executive Vice President and Chief Operating Officer of Geisinger Health System’s Clinical Enterprise. He began his career at Allegheny General Hospital in Pittsburgh and then joined McKinsey & Company as a leader within their health care practice. Shapiro is a fellow of the American College of Healthcare Executives, Chair Elect of the Greater New York Hospital Association Board of Governors 2013-2014, and is on the board of Crutches 4 Kids.

Institution Brief

New York-based Hospital for Special Surgery (www.hss.edu; HSS) is internationally recognized as the leading independent academic medical center specializing in orthopedics, rheumatology, and their related specialties. The hospital pioneered the modern-day total knee replacement and continues to build on its success in all areas of musculoskeletal health care, in the advancement of cutting-edge research, and the development of innovative approaches to diagnosis and treatment, all of which contribute to its global leadership. Outstanding results in quality of care and the patient experience have created a growing demand for its services with people coming to HSS from across the country and around the world. HSS is the first hospital in New York State to achieve its third consecutive designation as a Magnet Hospital by the American Nurses Credentialing Center, the gold standard for nursing excellence. It is the only hospital in New York State that has maintained a significantly lower infection rate than the state average for hip replacement four years in a row. Its physicians are the official team doctors for the New York Giants, New York Mets, New York Knicks, New York Liberty, and New York Red Bulls. HSS is also the official hospital of The PGA of America and an orthopedic consultant to the New York Road Runners for the ING New York City Marathon. This year, HSS was designated as the first National Medical Center of the United States Olympic Committee’s National Medical Network. In this capacity, HSS is an official hospital for U.S. athletes.

To what do you attribute HSS’s many successes?

Last year, we had people visit us from 90 countries and every state in America. They decided to travel here because they had conducted research and developed an informed point of view based on facts or word of mouth that this is where they had the highest probability of getting the outcome they wanted.

Patients who come here don’t have to come here – they have chosen to come here. Given that choice, we have high expectations to meet.

Our patients send me letters about their experiences. Most are good and some have recommendations – these letters provide us with opportunities to do better. Press Ganey also surveys all of our patients and we get a very high response rate.

The survey asks our patients 70 different questions. In any industry that is service-oriented, the most important question addresses how likely they are to recommend us to their family, a friend or a co-worker. For 20 consecutive quarters, we’re in the 99th percentile for “likely to recommend” out of all the institutions across the country that are viewed as best in class. This is more important than any award.

Are there opportunities to expand the brand globally?

HSS is a global brand and we are expanding in different ways.

We’re continuing to grow our main campus hub – we’re twice the size that we were 10 years ago.

We also have locations in midtown; a presence within major companies in Manhattan where we provide on-site services; and offices in Long Island, Southern Connecticut, Westchester County, New Jersey, and Florida, and each of those sites is growing in size and scope.

We have relationships in Brazil and China. In Brazil, we have a partnership with Amil Par, one of the largest integrated delivery systems there, which was purchased recently by United Healthcare. They are trying to elevate their musculoskeletal presence, primarily in Rio de Janeiro and exploring extending this relationship to Sao Paulo, where we are now helping them develop their capabilities in advance of the upcoming 2014 World Cup and 2016 Olympics in Brazil.

In China, we have developed a program called the HSS-China Educational Exchange where we’re working with major universities in China to create opportunities to ensure that orthopedic surgeons are reaching the highest level of training and experience. This will help ensure that they can take care of a large population in which the need for joint replacement will increase exponentially. We’re doing this both by having people come here and by going to China, as well as by creating an electronic exchange where knowledge can be shared. We are also exploring other relationships both domestically and abroad to bring the value of HSS to other states and countries that want to replicate both our model of health care delivery and our results.

Have the major issues within health care reform in the U.S. been effectively addressed?

Not fully. You will often hear health care providers talking about volume to value. At HSS, we have always been creating value – this is all we do. We are trying to help people get the best possible outcome in the most efficient and effective manner – delivering the right care at the right time with zero avoidable complications from receiving that care. Most external indicators demonstrate that we are leaders in providing safe and effective care.

Health care reform is trying to improve quality and holding providers accountable for that – if not, they won’t be paid.

HSS had the highest earn back for value-based purchasing last year compared to all other institutions. Do we still plan to be better? Absolutely.

Health care reform is trying to tackle the issue of cost. There is not enough emphasis being placed on preventive care. If people wouldn’t smoke, if they weren’t overweight, and if they exercised, you would see health care costs plummet. In running a hospital or for that matter, any type of organization, preventing things from going wrong rather than fixing them afterwards is much more effective.

Another issue is that the profit equation in the industry is lopsided; those that are providing the goods and services to those providing the care are much more profitable as organizations than the very doctors and hospitals that are providing care to patients. This formula needs to change and we are doing our part to help change it.

While this is a global brand, what does HSS mean to New York?

New York is home. HSS was founded 150 years ago by a physician who wanted to take care of children who didn’t have access to care and who had limitations on their ability to become productive adults.

We have never taken our focus away from being a leader in helping people get their mobility back. We are constantly inspired to go well beyond where we are today and we are always working to do that.

HSS is a value-based model of excellence in health care delivery. As models are undergoing experimentation to explore solutions for our nation’s health care problems, they can look to HSS on the Upper East Side to learn valuable lessons on how to create real value.•