The New Gold Standard in Surgical Pre/Post-Op — Orthopedics

Memora Health
4 min readDec 18, 2018


Over 10 million outpatient surgical procedures occur in the U.S. each year.
However, despite that volume, between 3–10% of all outpatient surgical procedures are cancelled days or even hours before an appointment. Hospitals and surgical centers are suffering as a result — cancellations cause disruptions in workflow, case load, and revenue. At Tulane University Medical Center, 6.7% of all scheduled outpatient surgeries were cancelled in 2009, costing the hospital nearly $1 million.

Studies have found that the top reasons for cancellation in ambulatory settings were patient no-shows and failure to follow pre-operative guidance. The study concluded that most of the cancellations were considered preventable.

Additionally, postoperative complications, including impaired recovery and surgical site infections (SSI), both hurt patient care and hamper busy hospital and clinic schedules. In fact, over 40% of patients over 65 suffer from postoperative complications. Similarly, postoperative pain and poor management of that pain significantly hinders patient outcomes — increasing hospital stays and costs of care.

This problem is particularly pronounced in orthopedic surgery

Nearly 40% of all elective orthopedic procedures are cancelled at least once. 12% were related to incomplete pre-operative preparation of patients.

When examining the average Medicare reimbursement for three of the most common orthopedic procedures: arthroscopy (CPT 29876, $740), joint replacement (CPT 27447, $1,408.30), and soft tissue repair (CPT 29888, $1,015.79), a 40% cancellation rate results in an average lost revenue of $1,265.52 per case.

Patients with higher pain scores following surgery for hip fractures had significantly longer hospital lengths of stay, more likely to have physical therapy sessions missed or shortened, less likely to be ambulating by post-operative day three, took significantly longer to ambulate past a bedside chair and had significantly lower locomotion scores at six months postop. This is not only harmful for patient care, but as more orthopedic operations move towards bundled payment models that track full episodes of care, will damage orthopedic department revenue and sustainability.

Similarly, patients who presented with surgical site infections following orthopedic surgery stayed a median of 14 extra days in the hospital during the follow-up period, twice as many hospital readmissions, and in many cases, additional operations.

In the case of one community hospital, the median total direct cost of hospitalizations per patient with surgical site infection was $24,344, compared with $6,636 per patient without an infection. The need to treat SSIs places severe financial strain on health care organizations.

In many cases, these problems are preventable. Identifying patients at high-risk of SSI, such as those with high serum glucose levels, improper administration of pre-operative antibiotic prophylaxis, or missed management of chronic disease can all be done both remotely and efficiently.

A Next-Gen Approach to Pre- and Post-Op

Because our team at Memora Health believe that in health care, the medium often helps define the message, we have distilled pre-operative preparation instructions and post-operative recovery instructions for orthopedic surgery patients into simple, easy-to-read text messages that are accessible on any type of cell phone — no installation needed.

However, since patients often have questions or concerns about instructions and their experience both before and after their operation, we’ve gone one step further — separating us from traditional IT solutions in a way that maximizes patient engagement.

We want to ensure that, whether it’s helping patients getting to the OR or making sure their recovery is as smooth as possible postop, they have the best course of care possible. Our goal is to help clinicians capture the value and reimbursement they deserve, in the order of thousands of dollars, without the fear of penalty, in the order of tens of thousands of dollars, for avoidable problems in surgical care. By improving the quality of pre-operative guidance for even a single patient per week, Memora helps clinician reimbursement increase by an average of $1,265.52 per week for orthopedic procedures.

Memora has designed a fully interactive, artificial intelligence-powered Q&A system over SMS that allows patients to text questions or concerns they have about preparing for their procedure so that there’s no lingering anxiety to keep them from showing up on the big day, and no questions they feel will be ignored on their road to recovery.

Orthopedic surgeons and ASC managers, reach out at! We’d love to work with you to help reduce no-shows, cancellations, and post-op complications, all while capturing lost revenue and improving patient care.

Memora Health is building the operating system for care delivery that implements intelligent, streamlined workflows and revolutionizes the patient experience outside the care setting. We offer a smart end-to-end platform that unifies fragmented health care data to enable providers, payors, and life science companies to automate care delivery operations — from patient communication to documentation to reimbursement. We uniquely use artificial intelligence to digitize existing care delivery workflows, giving clinicians infrastructure that learns from every encounter they have. Memora supports a full suite of virtual care systems from automated patient intake and scheduling to remote monitoring and care pathways to billing and documentation. Memora is backed by Andreessen Horowitz, SV Angel, Kevin Durant, Martin Ventures, and several healthcare strategic groups.



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