Orthopedics Overview

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• What is Blue Distinction®?

  Blue Distinction is a national designation awarded by Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality healthcare in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery or transplants. The designation is based on objective, evidence-based selection criteria established with input from expert physicians and medical organizations.

• What are Blue Distinction Centers®?

  Blue Distinction Centers are medical facilities that have received a Blue Distinction designation, after applying for and meeting objective, evidence-based selection criteria.

• What specialties does Blue Distinction recognize?

  Blue Distinction Centers for Specialty Care® are recognized for their distinguished clinical care and processes in the areas of:

  • Bariatric Surgery
  • Cardiac Care
  • Complex and Rare Cancers
  • Knee and Hip Replacement
  • Spine Surgery
  • Transplants

• How is Blue Distinction valuable to me?

  When you’re consulting with your patients about their specialty care needs, Blue Distinction can provide a valuable informational resource. Blue Distinction Centers have demonstrated expertise in delivering quality health care in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery or transplants.

  The designation is based on objective, evidence-based selection criteria established with input from expert physicians and medical organizations. The Blue Distinction designation can aid you in helping your patients find quality specialty care to meet their needs.

  Blue Distinction provides you with a local, regional and national outlook on the medical facilities that have met established selection criteria, which can lead to better overall quality of specialty care and patient results. Each Blue Distinction Center received its designation because it showed expertise in delivering quality specialty care through established care delivery and quality processes.

• What does Blue Distinction mean to my patients?

  When your patients are looking for specialty care, they can turn to your professional guidance as well as Blue Distinction as a supplemental source of additional information to help them in their research.

  The goal of Blue Distinction is to help you and your patients find healthcare facilities that have demonstrated better overall outcomes in delivering specialty care, such as fewer medical complications, fewer readmissions and higher survival rates. A better understanding of the quality and outcomes demonstrated by these facilities will help you and your patients have more informed conversations about why a Blue Distinction Center may be a good decision for their particular specialty care needs.

• How did you select these areas of specialty care?

  The six specialty areas of Blue Distinction account for more than 30 percent of total inpatient hospital expenditures.¹

  In developing Blue Distinction, we chose to focus on specialty areas that, together, are relatively high risk, high volume and/or high cost. The idea is to concentrate on those areas where we could realize the greatest impact—and make a difference in patient safety and outcomes.

• How many Blue Distinction Centers are there?

  There are approximately 1,900 Blue Distinction Center designations nationwide, across 47 states and the District of Columbia:

  • 540 Blue Distinction Centers for Knee and Hip Replacement®
  • 500 Blue Distinction Centers for Cardiac Care®
  • 350 Blue Distinction Centers for Bariatric Surgery®
  • 310 Blue Distinction Center for Spine Surgery®
  • 100 Blue Distinction Centers for Transplants®
  • 90 Blue Distinction Centers for Complex and Rare Cancers®

• What criteria do medical facilities have to meet to become Blue Distinction Centers®?

  To become a Blue Distinction Center, each medical facility must meet rigorous, evidence-based selection criteria. The Blue Distinction evaluation includes a broad range of quality criteria, from treatment through recovery. By using a number of factors that can contribute to quality care, you and your patients can get a clearer picture of how Blue Distinction Centers are structured to deliver better care—from expert teams of caregivers, to access to the appropriate hospital resources, to a commitment to quality improvement—within a given specialty procedure.

  The selection criteria used are publicly available to you and your patients on www.bcbs.com/bluedistinction.

  The following table provides a sampling of some of the criteria used to evaluate facilities for Blue Distinction:

  Selection Criteria Category	Examples
  Safety & Quality Outcomes	Complication rates Readmission rates Mortality rates
  Accreditation, Certification, and Expertise	Full facility accreditation by a Centers for Medicare & Medicaid Services (CMS)-deemed national accreditation organization Length of time a facility has performed a procedure Number of times a particular procedure has been completed Physician credentials
  Patient-Centered and Coordinated Care	Dedicated team focused on providing the particular area of specialty care Types of comprehensive care services and supporting departments provided (e.g., emergency room, diagnostic testing/ radiology, nutrition, social services, rehabilitation, etc.)
  Comprehensive, Evidence-based Care	Adherence to nationally-established care delivery measures Use of patient care protocols and adherence to evidence-based clinical care measures and guidelines Systematic follow-up on patient results after procedures
  Rapid Learning System	Quality improvement processes Use of clinical registry data systems

  To maintain its Blue Distinction Center designation, each facility must reapply periodically for re-designation. This not only encourages continuing quality at the facility level, but it also provides an opportunity for The Blues® to work with expert physicians and medical organizations to determine if any of the Blue Distinction quality thresholds should be raised to reflect current clinical practice. This process fosters ongoing opportunities for improving the overall quality of care.

• How do patient outcomes differ between Blue Distinction Centers and non-Blue Distinction Centers?

  Overall, Blue Distinction Centers have demonstrated better outcomes for patients. Here are just a few research findings that show why choosing a Blue Distinction Center can be a smart decision for you and your patients:

  Cardiac Care:

  • For every 1,000 cardiac bypass surgeries, 10 more people who chose Blue Distinction Centers for Cardiac Care® over non-Blue Distinction Centers are alive one month after surgery.²

  Transplants:

  • For every 1,000 adult heart transplants, 80 more people who chose Blue Distinction Centers for Transplants® over non-Blue Distinction Centers are alive one year after surgery. ²

  Bariatric Surgery:

  • Blue Distinction Centers for Bariatric Surgery® had a 26 percent lower complication rate for bariatric surgeries, and a 22 percent lower readmission rate for the most common bariatric procedure, laparoscopic gastric bypass. ³ 

• How do I find a Blue Distinction Center?

  The Blues have created a tool called the BDC Finder to help you search for Blue Distinction Centers. The interactive tool enables you to view a list of BDCs by specialty area and state, and is available at www.bcbs.com/bdc. You may also contact your local Blue Plan for more information.

• How do I learn more?

  To learn more about Blue Distinction, visit www.bcbs.com/bluedistinction.

• Notes

  1. Healthcare Cost and Utilization Project (HCUP), 2005
  2. BCBSA Analysis of 2005-06 Hospital RFI Data
  3. HealthCore Inc. Evaluation of Bariatric Surgery BDCs, 2009: WellPoint Data

  Note:  Designation as Blue Distinction Centers means these facilities' overall experience and aggregate data met objective criteria established in collaboration with expert clinicians' and leading professional organizations' recommendations.  Individual outcomes may vary.  To find out which services are covered under your policy at any facilities, please call your local Blue Cross and/or Blue Shield Plan; and call your provider before making an appointment, to verify the most current information on its Network participation and Blue Distinction status.  Neither Blue Cross and Blue Shield Association nor any of its Licensees are responsible for any damages, losses, or non-covered charges that may result from using this resource or receiving care from a Blue Distinction provider.