Impact of an integrated practice unit on the value of musculoskeletal care for uninsured and underinsured patients

Limited access to specialty care for uninsured and underinsured patients may be exacerbated by traditional fee-for-service approaches to care that incentivize volume and intensity of services over value of care. The purpose of this study was to determine the impact of a value-based integrated practice unit (IPU) on access to musculoskeletal care and surgical outcomes in a safety-net population. A new IPU was implemented on 6/1/2016 at an established safety-net clinic providing musculoskeletal care in central Texas to supplement existing musculoskeletal care provided through a fee-for-service model. This retrospective cohort study compared access and outcomes under the IPU to the parallel fee-for-service clinic through 3/31/2017, as well as the historical fee-for-service clinic from 8/1/2015 through 5/31/2016. Primary outcomes for access included number of referrals addressed; for surgical patients, length of stay, discharge destination, and 30-day readmission rates were assessed. The baseline waitlist of 1401 referrals on 6/1/2016 was eliminated by 3/31/2017. Among patients undergoing hip or knee replacement, length of stay was 1.4 days compared to 2.6 days for patients referred to the parallel fee-for-service clinic (p