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Comment & Response
July 2016

Behavioral Screening and Intervention for Improving Lower-Extremity Arthroplasty Outcomes and Controlling Costs—Reply

Author Affiliations
  • 1Value-Based Delivery, Northwestern Memorial HealthCare, Chicago, Illinois
  • 2Managed Care, Northwestern Memorial HealthCare, Chicago, Illinois
  • 3Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2016;151(7):686-687. doi:10.1001/jamasurg.2015.5548

In Reply We note and appreciate Dr Brown’s point that team-based care is essential for the deployment and success of managing episodes of care, especially in risk-based accountable payment models such as bundles. Indeed, Dr Brown is correct in stating that behavioral health professionals “have helped transplant surgeons identify and manage behavioral health conditions that frequently worsen outcomes.” It was not our intent to be exclusive when we cited nontraditional partners such as skilled nursing facilities and home health agencies. We actually consider behavioral health care professionals to be traditional partners in providing care to our transplant recipients. As Dr Brown points out, the pretransplant assessment and posttransplant management of transplant recipients often include behavioral health professionals (eg, social workers, psychologists, and psychiatrists), and, in fact, this is mandated by the regulations that govern transplantation.1 Thus, in contrast to skilled nursing facilities and home health agencies, the behavioral health disciplines are, without exception, considered part of the transplant care team and are included in the faculty and staff of the transplant program/institution. We do, however, agree that there is opportunity to more broadly and consistently include behavioral health professionals in the assessment and management of patients beyond transplant episodes of care.

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