New Journey

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NEW

JOURNEY

Changing the way orthopedic care is delivered to improve quality and increase patient satisfaction

Orthopedics & Spine Center

QUALITY & OUTCOMES REPORT 2015

Health care in our country and in our community continues to

evolve at a rapid pace. While many of the public discussions are on coverage and costs, the real work behind the scenes is focused on using data and the mission to develop best practices to deliver value-based care. What that means to patients, providers, and payers alike is simple: Provide exceptional care for the best value.

While the goal can be simply stated, the process to get there is more complicated.

As physicians, we must use data and research to carefully weigh every appointment, every test, and every procedure that we recommend for every patient. We must partner with our patients — and with providers throughout the continuum of care — to ensure that the treatment plan is being followed and that unnecessary or duplicated care is eliminated.

AT PANORAMA, WE BELIEVE: That we must strive to improve people’s quality of life That the patient experience drives all that we do That service, quality, and communication are essential to our success That change within our company is essential to our ability to deliver our promise

For more than 70 years, Panorama Orthopedics & Spine Center has been committed to advancing the delivery and results of orthopedic care in the Denver metro community. We are now seeing evidence that our model of care results in better outcomes, lower costs, and higher patient satisfaction. In fact, patient satisfaction at our hospital, OrthoColorado Hospital, ranks us among the best in the nation.

In addition, care at Panorama results in: pS horter average hospital stays after joint replacement and spine surgery pS horter average stays at skilled nursing facilities after orthopedic surgery pL ower surgery costs, fewer infections, and fewer complications Over the past year, we have continued to build our network of care, helping to ensure that patients can receive everything they need easily and efficiently. From doctors’ appointments to imaging through surgery and rehabilitation, our integrated network of care now spans the entire care continuum.

OrthoColorado Hospital is one of just 251 hospitals nationwide — and the only hospital in the Denver metro area — to receive a 5-star rating for patient satisfaction from the Centers for Medicare & Medicaid Services.

Completing this network allowed us to hit a major milestone this year — the introduction of Panorama OrthoPlus, a program that creates a custom care plan for surgical patients. Through this program, Panorama physicians, supported by a care navigator, coordinate care for each patient, starting with presurgery testing and preparation through surgery and the inpatient stay, and for three months after surgery. This program helps us to ensure that each Panorama patient is getting exactly what is needed at exactly the right time to ensure the best possible outcome.

Providing exceptional care for the best value. That’s the vision that inspires our work.

Thomas G. Friermood, MD

President Panorama Orthopedics & Spine Center

Pete Deol, DO

Physician Director of Outcomes Panorama Orthopedics & Spine Center

Mitchell D. Seemann, MD

Medical Director Panorama Orthopedics & Spine Center

COMPREHENSIVE in ONE SYSTEM

For nearly a decade, Panorama Orthopedics & Spine Center has been working to improve orthopedic care while lowering costs by building a comprehensive care network. This network is fundamental to ensuring that the most effective standards of care are being implemented throughout a patient’s entire journey of care. Today, Panorama includes: ORTHOPEDIC PRACTICES WITH ON-SITE PHYSICAL THERAPY HAVE LOWER COSTS AND FEWER VISITS THAN OUTSIDE PROVIDERS. Source: General Accounting Office, 2014

Three medical offices in the Denver metro area: • Golden • Westminster • Highlands Ranch p Physical therapy and occupational therapy p Massage therapy and acupuncture p X-ray and MRI imaging pO utpatient surgery at Golden Ridge Surgery Center, dedicated to orthopedic patients p I npatient orthopedic surgery at OrthoColorado Hospital, the state’s only orthopedic specialty hospital p D1 Sports, an athletic training and sports performance center p A medical supply store pP artnerships with select skilled nursing facilities that use best practices to help patients recover quickly and return home sooner p

The beauty of Panorama is that they could tackle our complicated set of problems with subspecialists all working under one roof.”

— HARRIET HOLLOWAY

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Quality & Outcomes Report 2015

CARE

CONSIDER COST AVERAGE COST Knee Replacement

IMPROVED RESULTS, HIGHER SATISFACTION By overseeing all aspects of a patient’s care, from symptoms to recovery, Panorama Orthopedics & Spine Center can provide the highest quality orthopedic care in the most efficient manner possible. We call that value-based care and using this model, we can: p Provide better clinical outcomes pH elp our patients feel better and do more sooner p Increase efficiency p Standardize costs pE liminate fragmentation, duplication, and waste

18.4% lower than Denver

17.4% lower than Nat’l

18.2% lower than Denver

14.6% lower than Nat’l

Hip Replacement

PANORAMA’S COST Panorama’s average cost for commercially insured knee replacement patients is 18.4% lower than the average cost in Denver and 17.4% lower than the average cost nationally. Likewise, Panorama’s average cost for commercially insured total hip replacements is 18.2% lower than the Denver average and 14.6% lower than the national average.

Source: Denver and national costs from Jan. 21, 2015, Blue Health Intelligence report. Panorama average costs from the Colorado Center for Improving Value in Health Care for these surgeries at OrthoColorado Hospital.

PHOTO BY DAVID TAN

Still gittin’ ‘er done Wilburn Holloway is a seasoned Kansas farmer fond of working the land and saying “git ’er done.” But sometimes he looks up — way up — at his 25,000-bushel grain bin and catches his breath. “How did I survive that?” he’ll mutter before climbing into his John Deere tractor.

On July 6, 1998, Wilburn did what he had done so many times before.

He climbed to the top of that bin to close the lid. A rainstorm was coming, and the moisture would ruin his wheat. Holloway hoisted the huge metal lid at precisely the moment a wind gust ripped across his farm, whooshing under the lid and knocking him a staggering 43.5

feet to the ground.

He broke his left femur, three vertebrae in his lower back, both legs below the knees, and every bone in his right foot. Both rotator cuffs were torn, and he had a severe concussion. He was immediately put on a medical flight to Denver.

While Holloway underwent a spate of early surgeries to reconstruct his mangled foot and repair his badly broken legs, neighbors harvested his wheat and looked after his three teenage sons.

“We were told that half of all people who fall 15 feet die. Yet here was Wilburn, who fell three times that distance. Dr. (Bharat) Desai said

it was the most complicated case he had ever seen,” Harriet Holloway says, counting 22 surgeries in 17 years on her husband’s feet, ankles, legs, back, and shoulders. “Today, you wouldn’t know there is anything wrong with him, except for the way he rolls his right foot when he walks.”

Wilburn enjoys the simple things in life even more than he did before.

In a seasonal pattern, he plows, plants, irrigates, harvests, and hauls.

“My biggest pleasure? Mostly I love to watch corn grow. That’s the life of a farmer.”

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RIGHT CARE

The at the RIGHT TIME At Panorama, we are guided by one principle — doing what’s right at the right time for each individual patient. For most, that will mean conservative therapies such as physical therapy or acupuncture and massage. For others, it may mean a simple pain-relieving injection and for others, surgery can be the right call.

HELPING PATIENTS FEEL AND FUNCTION BETTER To develop the best care plan for each patient, Panorama physicians collaborate with a pain management team — physiatrists, imaging technicians, and physical therapists — on the best conservative treatment options. We offer a variety of proven methods for pain management to help patients heal, including: p Physical therapy p Injections p Radiofrequency ablation pM anipulation of scar tissue in tendons to promote healing pM edical massage to reduce pain and muscle tension for many conditions, including spine problems, post-op pain, and orthopedic injuries pA cupuncture to reduce pain from arthritis, carpal tunnel syndrome, sciatica, nerve damage, and many other orthopedic problems

MINIMIZING TRAUMA, MAXIMIZING OUTCOMES When surgery is the right choice, we combine expertise, evidence-based practices, and the latest technology to perform the procedure that will result in the best outcome. Where possible, we utilize the newest minimally invasive techniques that can provide: p Less trauma to the body p Less bleeding p Less scarring p Less pain and need for narcotics p Shorter hospital stays p Faster recoveries

GETTING THE JOB DONE

Panorama’s focus on providing the right care at the right time for each patient shows in our numbers:

1.82 days

1.84 days

2.35 days

average length of hospital stay for total hip replacement (national average: 3.9 days)

average length of stay for total knee replacement (national average: 3.1 days)

average length of stay for spinal fusion (national average: 3.0 days)

Sources: OrthoColorado Hospital; Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project, 2012 data

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Quality & Outcomes Report 2015

Back in the ‘swing’ of things

Viscosupplementation for knee arthritis Partial joint replacement for localized arthritis Hip resurfacing for hip arthritis Hip arthroscopy for labral tears Arthroscopic cartilage restoration Minimally invasive spine and joint replacement

I can tell that my right hip — the one I got replaced — works better than my left hip. It just moves easier.”

— BETSY STEELMAN

PHOTO BY ELLEN JASKOL

LESS INVASIVE TREATMENTS OFFERED BY PANORAMA

Retired from software technology sales, Betsy Steelman has always been a mover and a shaker. So the 56-year-old Castle Pines resident wasn’t about to let a bum hip tarnish her golden years.

“I’m active. My passions are travel, yoga, golf, and my grandson,” Steelman says. Early last year, she began to have pain in her right groin. But, as is often the case, her “groin” pain was actually radiating from her hip.

In September, X-rays revealed that the cartilage around her hip joint was completely gone. Her pain worsened, and shot down her leg with even simple activities, such as loading the dishwasher and grocery shopping. “I faced the prospect of becoming more sedentary. Then the thought struck me, ‘I’ve got a lot of life to live here.’”

She researched her options — getting second and third opinions — and finally settled on total hip replacement with Panorama Orthopedics & Spine Center, where William Peace, MD, specializes in an anterior, or “front,” approach to the surgery. “It’s less invasive, there’s far less blood loss, recovery time is quicker, and you don’t have nearly the amount of restrictions in how you can move following surgery,” Steelman says.

Steelman is so serious about her golf game that she scheduled surgery for December, when her clubs would be collecting dust anyway. “Instantly there was no pain,” she says. “It was amazing.”

By the end of January, she played 18 holes of golf. By the end of February, she was back to yoga — totally unafraid to try poses that required putting her body weight on her right leg. “Looking back, I realize that pain limited everything. By choosing surgery, I was choosing my lifestyle,” she says.

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The VALUE in

SPECIALIZED orthopedic care Panorama Orthopedics & Spine Center focuses on one thing only — we treat musculoskeletal conditions. And while many orthopedic surgeons across the county treat the entire body, at Panorama, each of our 32 orthopedic surgeons specializes in a particular area of orthopedics. For the patient, that means if you have a foot problem or a hip problem or a back problem, you will see a doctor who is highly specialized in that particular area of orthopedics.

FACT: SURGEONS WHO PERFORM THE MOST TOTAL KNEE REPLACEMENTS HAVE FEWER INFECTIONS, SHORTER HOSPITAL STAYS, AND BETTER PATIENT-REPORTED OUTCOMES THAN SURGEONS WHO DO FEWER PROCEDURES.* PANORAMA SURGEONS PERFORMED 1,124 TOTAL KNEE REPLACEMENTS IN 2014.

And at our hospital, OrthoColorado Hospital, we do one thing only — orthopedic surgery. And from our physical therapists to our imaging specialists, each is specialized in the care of orthopedic patients.

Our focus on specialization revolves around one guiding principle: excellence.

You see, we believe that our highly specialized focus on orthopedic care enables us to: pM ake more accurate diagnoses pD evelop more effective and efficient treatment plans pA void unnecessary care pP erform the most effective and leading-edge procedures pA chieve better outcomes p Shorten hospital stays p Reduce infections and complications pA chieve higher patient satisfaction

*Source: BMC Musculoskeletal Disorders

OUR ORTHOPEDIC SUBSPECIALTIES Every Panorama physician is fellowshiptrained in a specific area of orthopedic medicine, including: • Sports medicine • Spine • Trauma • Hand 6

• Hip arthroscopy • Joint replacement • Foot and ankle • Nonoperative pain management

A PRIVATE PRACTICE IN AN ACADEMIC ENVIRONMENT Doctors who are specialized in one area of orthopedics have the ability to gain vast experience with both rare and common conditions. They perform many of the same procedures frequently, allowing them to achieve better patient outcomes, according to multiple studies. This approach also provides the physicians with the opportunity to stay updated on rapid changes in their subspecialty area to continually offer their patients the latest treatment advances.

Each subspecialty team — comprised of physicians, physical therapists, a nurse manager, and others (as appropriate) — meets regularly to collaborate on treatment plans for complex cases and review performance on other cases.

During these conferences, the teams also discuss new research and emerging advancements. Working in close proximity in our three office complexes, surgical centers, and our specialty orthopedic hospital also means that our physicians and other practitioners have ample opportunity to collaborate informally, as well.

Like our physicians, our physical therapists work in highly specialized areas within orthopedics. For example, a patient who has had a knee replacement would see a physical therapist who specializes in therapy for knee replacements. Radiologists and imaging technicians also specialize in orthopedics.

COLLABORATING WITH REFERRING PHYSICIANS

Panorama surgeons serve as team physicians for: • Colorado School of Mines • Regis University • Metropolitan State University of Denver • Jeffco Public Schools

Referring physicians are a key part of our extended team. We work hard to coordinate the care of their patients with them, and to keep them informed about the care we provide, including: pS ending an electronic note to the referring physician the day of the visit pC alling the referring physician after major surgery pO ffering a physician hotline so referring physicians can reach Panorama physicians quickly and easily

CASE STUDY

The right diagnosis changes course for cyclist For about five years, a 55-year-old male who spent much of his leisure time cycling struggled with severe pain in his foot. He tried orthotics, activity modification, medication, and physical therapy — but nothing eased his pain. Other doctors diagnosed severe ankle arthritis and told the patient that he needed an ankle fusion or a cartilage implant.

In-depth knowledge leads to pain relief and better function Then the patient attended a community seminar on cartilage restoration at OrthoColorado Hospital given by Bharat Desai, MD, a foot and ankle and musculoskeletal trauma specialist at Panorama. The patient went to see Dr. Desai, who suspected the pain wasn’t coming from the ankle at all, but from the subtalar joint just below the ankle. By combining his in-depth knowledge of foot problems

with imaging and injection of the corticosteroid Depo-Medrol into the subtalar joint, Dr. Desai confirmed his suspicions: The patient had severe arthritis in the subtalar joint.

Instead of an ankle fusion, which would have limited the patient’s ankle motion and meant he would have had to stop cycling, Dr. Desai recommended a subtalar fusion. Dr. Desai performed the outpatient procedure, which relieves pain and restores function while also protecting the ankle joint, in May 2015.

Return to function and cycling The week after surgery, the patient began physical therapy. At four weeks post-surgery, he began riding an exercise bike as part of his therapy. Dr. Desai expects him to return to nearly full function, except for limited ability to walk on uneven surfaces. Within about three months of surgery, the patient will be back on his bicycle, enjoying outdoor Colorado again.

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SUPERIOR OUTCOM through EXPERTISE and integration

By combining the in-depth orthopedic expertise of Panorama physicians with our vertically integrated model and a focus on continual improvement, we achieve patient satisfaction, and clinical and cost outcomes that are well above national and state averages.

PATIENT SATISFACTION MEASURES

Patients who reported YES, they would definitely recommend the hospital OrthoColorado Hospital was rated a 5-star hospital for patient satisfaction by the Centers for Medicare & Medicaid Services: p One out of 251 5-star hospitals nationwide p The only 5-star hospital in the Denver metro area Patients who gave their hospital a rating of 9 or 10 (scale of 0, lowest, to 10, highest)

100%

100%

85%

80%

80%

75% 60% OrthoColorado Hospital

Colorado Average

Patients who reported YES, they would definitely recommend the hospital

84% 75%

71%

60%

National Average

OrthoColorado Hospital

Colorado Average

Source: Centers for Medicare & Medicaid Services (medicare.gov/hospitalcompare)

OrthoColorado Hospital’s patient satisfaction ranks in the top 1 percent of hospitals nationally for: p Doctors listening carefully to patients: 88.8% p Patient staff listening carefully to patients: 91.9% p Staff doing everything they could to help with pain: 87.7% p Overall rating of hospital: 88.8% p Likelihood to recommend: 91.3% Source: Hospital Consumer Assessment of Healthcare Providers and Systems

Patients at Panorama’s Golden Ridge Surgery Center report overall satisfaction with:

97.6%

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PAIN MANAGEMENT

Quality & Outcomes Report 2015

97%

SURGICAL OUTCOMES

71% National Average

OMES CLINICAL OUTCOMES MEASURES Surgical site standardized infection ratio

Compared to the National Institutes of Health national standard of 1.0 evaluated annually over 12 months: p Spinal fusions: 0.07 p Total hip replacement: 0.4 p Total knee replacement: 1.1

Average length of hospital stay 1.82 days

1.84 days

2.35 days

average length of stay for total hip replacement (national average: 3.9 days)

average length of stay for total knee replacement (national average: 3.1 days)

average length of stay for spinal fusion (national average: 3.0 days)

Source: Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project, 2012 data

Golden Ridge Surgery Center

se of surgical safety checklist: 100% U DVT/blood clot rate within 30 days of surgery: 0% p Wrong site surgery: 0% p Transfer to hospital for advanced care: 0.1% p Return to surgery within 48 hours: 0% p

FACT: 100% OF SURGERY PATIENTS AT ORTHOCOLORADO HOSPITAL RECEIVE AN ANTIBIOTIC AT THE RIGHT TIME TO HELP PREVENT INFECTIONS.* RECEIVING A PROPHYLACTIC ANTIBIOTIC IS IDENTIFIED AS ONE CRITICALLY OR SIGNIFICANTLY IMPORTANT FACTOR IN PREVENTING SURGICAL SITE INFECTION IN TOTAL JOINT REPLACEMENT, ACCORDING TO A SURVEY OF SURGEONS IN THE INTERNATIONAL SOCIETY OF ORTHOPEDIC CENTERS.** Sources: **CMS, July 2013-June 2014 **HSS Journal, 2014

p

FACT: OUTCOMES FOR PATIENTS UNDERGOING HIP AND KNEE REPLACEMENT SURGERY ARE BETTER AT SPECIALIZED ORTHOPEDIC HOSPITALS, LIKE ORTHOCOLORADO HOSPITAL. Source: British Medical Journal, 2010

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COST MEASURES Joint replacement costs

According to the Colorado Center for Improving Value in Health Care, the average cost for privately insured patients at OrthoColorado Hospital from 2009-2012 (the most recent data available) is lower than most Colorado hospitals in the database. Some examples: HIP REPLACEMENT: 29% lower at OrthoColorado Hospital than at Rose Medical Center

KNEE REPLACEMENT: 50% lower at OrthoColorado Hospital than Poudre Valley Hospital

Medicare hospital spending per patient A ratio that is less than the national average means that Medicare spends LESS per patient for an episode of care initiated at this hospital than it does per episode of care across all hospitals nationally.

OrthoColorado Hospital: 0.90 Colorado average: 0.96 National average: 0.98

Source: Medicare (medicare.gov/hospitalcompare)

VOLUME MEASURES Procedure volume by orthopedic subspecialty

2011 2014 Joint Replacement Total hip replacement 436 599 Total knee replacement 847 1,124

Sports Medicine Rotator cuff repairs ACL reconstructions

Total procedure volume 2014 3,306

6,944

2,311 531 408

664 427

149 47

180 62

Golden Ridge Surgery Center OrthoColorado Hospital St. Anthony Hospital

2011

Foot & Ankle Care Bunion correction Achilles tendon repair

Hand & Elbow Care Wrist fracture Carpal tunnel

45 106

Spine Care Spine fusion Laminotomy

346 387 326 385

33 143

3,055 2,320

5,010

Golden Ridge Surgery Center OrthoColorado Hospital St. Anthony Hospital

COMING SOON: PRACTICE OUTCOMES Panorama is developing a Web-based system to measure clinical performance for the most common procedures in each orthopedic subspecialty. As we reorganize our system of data collection, we will soon be publicly reporting data across our entire practice and surgical facilities, including clinical outcomes, infection rates, complications, and patient improvement.

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Quality & Outcomes Report 2015

CASE STUDY

Specialized orthopedic trauma care saves man’s arm A 47-year-old man arrived at St. Anthony Hospital in February 2015 with a crushed arm, after his car rolled over onto the arm during an accident. Panorama’s orthopedic trauma surgeons were able to save the patient’s arm. Five months after the accident, the patient is on the path to regaining full function.

In-depth surgical experience leads to optimal outcome Peter Lammens, MD, the Panorama orthopedic trauma surgeon on call that day, cleaned the open wounds and stabilized the patient’s arm. He then called upon his colleague, Edmund Rowland, MD, a specialist in both trauma and hand surgery, to continue the patient’s care with additional wound debridements, to remove unhealthy tissue, prevent infection, and eventually repair the fractures with plates and screws. Our plastic surgery colleagues at St. Anthony Hospital were able to close the open wounds with skin grafting and tissue flaps.

Expert, integrated physical therapy accelerates healing Through Panorama’s network of subspecialized physical therapists, the patient’s recovery is more predictable in the hands of our group of Occupational/Hand Therapists. The close interaction with the members of our entire hand/elbow team allows for changes to be made to therapy or treatment within minutes of an issue being identified. This is teamwork! And better patient care!

Specializing in trauma Care Dr. Lammens and Dr. Rowland, along with the other Panorama physicians covering the Level I Trauma Center at St. Anthony Hospital, specialize in orthopedic trauma as well as other subspecialties within orthopedics. The trauma team at Panorama delivers a higher level of care than surrounding facilities, in that we also provide subspecialized orthopedic trauma care.

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Continual

ADVANCES in

care, service, and efficiency

From offering the latest innovations in orthopedic treatments to improving the patient experience, opening new facilities, and participating in a federal program to provide better, more coordinated care at a lower cost, Panorama is always evolving and improving.

RECENT ADVANCES OFFERED

BY PANORAMA

ENSURING THE HIGHEST LEVELS OF PATIENT SATISFACTION

SURGERY: p Hip arthroscopy p Minimally invasive joint replacement surgery p Minimally invasive spine surgery p Use of stem cells to augment healing in select spine and foot and ankle procedures

Patients deserve great service and clear communication. That’s why Panorama has a dedicated patient experience manager to analyze and improve processes for interacting with patients.

In an effort to provide excellent patient care, the patient experience manager is: p Training employees on improved models of communication p Observing and improving communication during physician-patient visits p Posting and managing “Tell Us How We’re Doing” boxes throughout the practice for patient suggestions and complaints p Establishing a process to track and follow up on issues that are important to our patients

PATIENT EXPERIENCE: p Added a Patient Experience Manager p Launched the Panorama OrthoPlus program to provide coordinated and comprehensive care for patients facing surgery, from their first visit through recovery PATIENT ACCESS: p New Highlands Ranch orthopedic campus: medical office, physical therapy, MRI and X-ray imaging, and D1 Sports athletic training center

NEW HIGHLANDS RANCH FACILITY WITH AN ATHLETIC TRAINING CENTER Panorama’s newest facility in Highlands Ranch includes a large medical office, MRI and digital imaging center, physical therapy services and in partnership with D1 Sports, an athletic training and sports performance center. This new location replaces two older offices in Littleton, accommodating more physicians and patients and offering a full range of orthopedic and spine care.

Returning athletes to play The athletic training center bridges the gap between post-surgery physical therapy and return to sports. Designed to safely restore athletes to optimal performance, the center integrates motivational sports-oriented training and therapy.

D1 Sports is also open to athletes of all ages and abilities who are interested in forming a coaching relationship to achieve the highest levels of athletic fitness. D1 Sports offers classes for youth, adults, and seniors in either a group setting or with individual trainers. Its highly trained coaches work with individuals who want to lose weight, increase athletic performance, or who need personal encouragement to push their fitness to the next level.

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Quality & Outcomes Report 2015

SPECIAL CARE FOR MEDICARE PATIENTS As part of a special Care Improvement Initiative for Medicare, Panorama is assuming financial and performance accountability for orthopedic surgery in Medicare patients. Under the program, many of our Medicare patients are enrolled in a program to bundle costs for their care. From joint replacements to shoulder surgery to ankle surgery to back surgery, Panorama is leading the way in developing a model for higher-quality care at a lower cost. Panorama is one of only a few private orthopedic practices nationwide — and one of three in Colorado — participating in this program.

Off the sidelines A physical education teacher for 25 years, 61-year-old Gunnison resident Vicki Wattier spent the last three years of her teaching career sitting on the sidelines while her students ran and played. “I got to the point where my knee was deformed. I had bone spurs and lots of nerve damage,” she says.

Arthritis began limiting her full participation in sports, too. Tennis and skiing became extremely difficult. She couldn’t hike or bike without pain. And the fly-fishing she enjoyed? Out of the question.

“Fly-fishing requires stability and good range of motion. I couldn’t even bend my knee 90 degrees.”

In 2011, she learned of a unique, minimally invasive knee replacement technique offered by Jared Foran, MD, a joint replacement specialist at Panorama Orthopedics & Spine Center.

“I like new technology and innovative approaches to things,” she says. “There’s not too many doctors who perform total knee replacement the way he does. Dr. Foran does this small incision — kind of like a reverse comma shape — that starts right above the kneecap and curves toward the inside of the leg. It’s real short, probably only 3 inches long.”

Wattier was up and walking the day of surgery. Shortly after her October 2011 knee replacement, she was living life at full tilt again.

Today, she spends winters as a cashier at Crested Butte Mountain Resort, where one of the perks of the job is a ski pass that she uses 50 to 60 times every season. She’s back to hiking, biking, swimming, and playing golf. “I wish I had done the surgery sooner. I’m pain-free, and I have full range of motion. It’s great.”

PHOTOS BY ELLEN JASKOL

Dr. Foran’s knee replacement technique is less painful, less damaging to cartilage and tissues, and there’s a quicker recovery. I liked the idea of getting back to activities more quickly following surgery.”

— VICKI WATTIER panoramaortho.com

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OrthoPlus:

Changing the delivery of orthopedic surgery

Until now, health care has been delivered to patients without much coordination across providers, hospitals, and rehabilitation centers. This lack of coordination is not just frustrating for patients and their families, it is inefficient and results in less-than-optimal outcomes and often higher costs.

Navigating care

An essential piece of OrthoPlus is our team approach to navigating the journey of care. From a specially trained orthopedic nurse to our team of physical therapists, each surgical patient can expect to meet with a team member to create a custom care plan for surgery and recovery.

Each patient receives the personal attention, planning, and resources necessary for the best and fastest recovery. The OrthoPlus program offers patients a variety of benefits: p Logistics: Planning and coordinating appointments, medical records, test results, care plans, and necessary medical equipment with their entire medical team. p Presurgery planning: Educating patients about the steps they can take to help improve their outcomes, such as: • Medication checks • Preparing the home • Presurgical exercise routines • Controlling chronic diseases, such as diabetes or heart conditions p Post-surgery coordination: Making arrangements for follow-up care through outpatient physical therapy, home care, or transfer to a skilled nursing facility, with the goal of achieving the best outcome while also returning the patient home as quickly as possible. p Support services: For three months following surgery, we are dedicated to working closely with patients as they journey through the recovery process. Through OrthoPlus, patients have the ability to call a medical provider 24 hours a day, seven days a week, with questions or concerns. The care provider has immediate access to the patient’s care plan and medical team should they need advice or care. This feature is a key piece to avoiding complications, reducing readmissions to the hospital, and ensuring proper access to necessary care.

One of the highlights of getting better has been going to PT and learning new exercises.

I still do them at home.”

— PATRICK ALMDALE

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Quality & Outcomes Report 2015

From start to finish When Patrick Almdale started to lose distance off the tee, the avid golfer chalked it up to age. But when the 66-year-old Westminster resident could hardly swing his driver — much less reach for the salt shaker at dinner — he knew something was wrong.

“I’m not a woe-is-me-er,” Almdale says, noting that after trying to strengthen his arm on his own, he turned to Panorama for surgery. “I had no cartilage left in my shoulder. I was bone on bone,” he says.

Before and after shoulder replacement surgery by David Schneider, MD, Almdale benefited from a new Panorama program called OrthoPlus. The program coordinates care for patients, starting with presurgery preparation and continuing through surgery and rehabilitation — rather than each of these critical components happening in piecemeal fashion.

Almdale says he went into surgery knowing what to expect in terms of pain and armed with tricks to help with everyday activities such as dressing. He felt confident going home the day after surgery.

And he describes outpatient rehabilitation as a highlight. “I’ve done PT before. I definitely saw a difference at Panorama. They know who your doctor is; they are familiar with patients and rehabilitation goals. They had access to my chart. It was all under the same roof — I liked that,” he says.

Looking forward to his next golf trip, he’s not one to just sit idle. In fact, at just four months post-op, Almdale is already making his way up and down — and up and down — an extension ladder to paint the exterior of his house. “I’m a mover. I fix everything around my house,” he says, glad that the Panorama staff is made up of fixers, too. “To be able to do the things I’m doing now at the earliest part of my recovery, I couldn’t be happier.”

PHOTO BY ELLEN JASKOL

In our quest to continually advance the way care is delivered to achieve better results, Panorama is pleased to introduce a new program this year called Panorama OrthoPlus. This program is designed to overcome the disjointed system of health care by putting a surgeon and team in place to oversee a patient’s care from the first visit to three months after surgery.

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PHOTO BY LINDE WAIDHOFER

‘Back’ to the slopes

My surgeon is an enthusiastic skier.

He took it seriously that I was an active mountain enthusiast, and he wanted me to stay that way.”

At 74, Lito Tejada-Flores fancies himself a “freelance human being.”

The Crestone resident has written “how-to” books on skiing; produced videos on skiing; and taught skiing in the Rockies, the Sierras, and Switzerland. These endeavors have supported his

— LITO TEJADA-FLORES lifelong love for skiing and engaging, as he styles it, in the “impossible romance of sliding over snow.” It’s been one good, long run. Until his back balked.

His back problems began 13 years ago when he fell from his home’s roof and suffered a burst fracture of the L3 vertebra. He was flown to Denver, where Panorama surgeon Courtney Brown, MD, fused his L2 through L4 vertebrae.

Tejada-Flores maintained his high level of activity for almost 10 years until two conditions — spondylolisthesis and spinal stenosis — started ganging up on him.

Spondylolisthesis results when one vertebra “slides” forward over the bone below it.

Spinal stenosis is a narrowing of spaces in the spine, which puts pressure on the spinal cord and nerves.

The result? For Tejada-Flores, a pins and needles sensation would strike his feet after 10 minutes of hiking in the nearby Sangre de Cristo Mountains. By January of 2015, acute, paralyzing pain struck. “Just standing at the kitchen counter for two to three minutes would be so painful that I needed to sit down.”

An MRI revealed what he feared was true: It was time for a second surgery. He again turned to the Panorama surgical staff. Douglas Wong, MD, removed the instrumentation from his former fusion, added the L5 vertebra to a new L2 through L5 fusion, and repositioned his vertebrae to create enough space to give the nerves room to heal. “When I came back to consciousness, the pain was gone. It’s been gone ever since. Surgery was 100 percent successful,” says Tejada-Flores, who is — not surprisingly — counting days until the snow starts to fall.

LOCATIONS Golden

Westminster

Highlands Ranch

OrthoColorado Hospital

660 Golden Ridge Road, Suite 250 Golden, CO 80401 303-233-1223

1060 Plaza Drive, Suite 200 Highlands Ranch, CO 80129 303-233-1223 720-214-7082 D1 Sports

8510 North Bryant Street, Suite 120 Westminster, CO 80031 303-233-1223

St. Anthony Medical Campus 11650 West 2nd Place Lakewood, CO 80228 720-321-5000

APPOINTMENTS 303-233-1223 | Toll Free: 1-800-258-5250 panoramaortho.com