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With so many parties involved in a patient’s medical care—even more so in the event of a work-related MSK disorder, each serves to benefit from a safe and quick return to normal. Enter Surgery optimization, a process built to improve outcomes for patients, employers, workers’ compensation players, and payers.

But what is musculoskeletal surgery optimization? How does it help to set a patient up for success, why does it work, and who serves to benefit from its use? We look to answer all these questions and more below.

Surgery Optimization—More Than the Sum of Its Parts

If a claimant suffers a musculoskeletal injury, the traditional approach to care goes as follows. First, the person speaks with his or her primary care physician. The primary care physician refers the patient to a specialist, who takes the least invasive approach to care. Often starting with injection therapy, providers will then move patients to physical therapy and finally to surgery.

Too often, however, the path to surgery relies exclusively on physical therapy. Patients put complete faith in physical therapy, when in reality, this is only part of the solution.

Can physical therapy help to strengthen the injured area, improve flexibility and endurance, and give a patient a head start on recovery? Yes. 

But is physical therapy going to help a patient understand what’s going through their head in the days leading up to the surgery? Is a weekly half-hour of facetime with a DPT going to help the patient understand the condition, surgery process, and recovery? Is a physical therapist going to help a patient understand potential hazards created by everyday objects or movements? Unlikely. 

Physical therapists play an important role in surgery preparation and recovery, but surgery optimization requires more than just PT. 

A Basic Definition: What Is Surgery Optimization?

So what is Surgery Optimization? In basic terms, Surgery optimization is everything that a patient or claimant does in the time leading up to surgery to improve the outcome and reduce risk and cost. 

Rather than the traditional approach of relying heavily or exclusively on physical therapy in the weeks leading up to the procedure, Surgery Optimization looks at the patient and their journey. 

Combining physical therapy with four other elements—nutrition, pain management and anxiety reduction, health literacy, and environmental preparation—this approach offers patients a complete understanding of the road ahead while delivering more value than one tactic alone. 

PreHab and ReHab: Optimization Before Surgery and a Guided Recovery After

Surgical success needs to start long before the surgery, helping a patient prepare for the initial challenges before pivoting toward recovery. Surgery Optimization, or PreHab, consists of a number of preparation steps, helping to promote positive outcomes for patients. 

But it doesn’t stop there. PreHab is not only getting a patient ready for surgery day, it’s also setting this individual up for ReHab, the recovery portion of surgery optimization. 

A Different Approach: Five Pillars of Surgery Optimization

Helping a patient feel like they’re ready for surgery requires them to be both physically and mentally ready for the procedure. As mentioned above, Surgery Optimization consists of five elements, something we at PeerWell call the Five Pillars of Health. When combined and delivered in approachable and personalized lessons, patients can feel confident about the procedure.

  1. Physical Therapy: The most common element of surgery preparation, physical therapy targets the affected area and focuses on strengthening, improving flexibility and endurance, and learning proper posture and movement. Necessary for providing a head start on recovery, patients can participate in this step directly with a provider or through the use of approved mobile at-home programs.
  2. Nutrition: The right nutrition can go a long way in promoting positive outcomes. Whether it’s getting a patient to the right weight or helping them identify what vitamins to embrace or avoid, understanding the nature of nutrition can mean better health and recovery.
  3. Pain and Anxiety: Surgery is scary, and pain is problematic. But often, patients are blindsided by the way their minds work before and after surgery. By focusing on mindfulness and providing support, PeerWell helps to minimize pain, alleviate jitters, and prepare a patient for what will happen after surgery.
  4. Health Literacy: Knowledge is power and a surprising amount of patients don’t fully understand their musculoskeletal condition, let alone the surgery or the recovery ahead. Helping patients understand the process can help to minimize anxiety and provide information needed to speed recovery and instill confidence.
  5. Environmental Preparation: Don’t let the home increase risk. Preparing for the non-surgical aspects of preparation and recovery can help offer a smoother and safer recovery. 

Why Do These Work? 

When combining efforts and providing patients with understandable, personalized, and accessible information, outcomes improve. In fact, with surgery optimization resulting in significantly shorter lengths of stay, more favorable discharge disposition status, and reduced need for health aides or skilled nursing facilities, many ask how it’s so effective.


The first and likely biggest reason is patient engagement. By providing a patient with all the tools they need and offering answers to questions they didn’t know they had, patients feel more confident in the days leading up to surgery. 

PeerWell goes even further by connecting with patients. Instead of pages and pages of literature or videos about what to expect, patients receive bite-sized tasks and bits of information at a reading level that works. 

Right Care, Right Time, Right Place

All treatment, whether musculoskeletal or not, requires the right interventions at the right time. Handing out a pamphlet about hazards in the home a month before a surgery can help, but is more likely to be ignored until patients and family are making last minute preparations. 

By offering information in daily tasks, patients can get the information they need when it’s most likely to help them. On the other side of the equation, TPAs and providers can see how engaged a patient is during this time as well, helping to plan those interventions.

Faster/ Safer/ Better Recovery 

When combining the elements of surgery optimization, providing them to patients in approachable and understandable ways, and giving them a clear path to the finish line, the result is something that everyone needs: Faster recovery, less risk, and better outcomes. 

How Patients, Payers, and Providers Save Time and Benefit from Surgery Optimization

Empowered patients are going to spend less time in the hospital recovering, require fewer visits to physical therapy before and after surgery, and come out of their surgery with less pain and more satisfaction. With so many entities relying on fast and successful recovery, here’s how surgery optimization has a ripple effect:

Patients: Fewer Days in the Hospital, Fewer PT Appointments

As the person going under anesthesia and going through the surgery, patients are the ones most likely to benefit from surgery optimization. In fact, according to a study on The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty, patients who participated in prehabilitation and surgery optimization experienced the following: 

  • Fewer Days in the Hospital: With the help of PeerWell, patients have a 26% reduced length of hospital stay after musculoskeletal surgery (2.0 days vs. 2.7 days). 
  • Less Reliance on Skilled Nursing Facilities and Home Health Assistance:  In the prehabilitation patients, 77.2% went home without assistance, compared to 42.8% in the control group. Similarly, significantly fewer patients in the prehabilitation group were discharged to a SNF when compared to the control group (1.8% vs. 21.8%). 
  • Fewer Trips to PT: The average number of outpatient physical therapy consultations (OP PT) per subject was just 2.04 visits. Comparatively, the average number of outpatient physical therapy visits per non-PeerWell patient is 7.4 visits per case.

These benefits to the patient are realized by the rest of the system as well.  

Employers: Less Downtime and Lower Workers Comp Payments

With more than half of U.S. Adults suffering from a musculoskeletal pain disorder, one of the most common sources for these injuries is the workplace. In turn, if an injury does occur in the workplace, the employer suffers, as well. MSDs represent one third of all workers’ compensation costs, resulting in direct costs of more than $20 billion and a lot more in indirect costs. 

If a patient is likely to recover faster and take fewer trips to physical therapy, that means that an employer is going to get their star employee back sooner and spend less on treating them. Learn more about common costs and days away from work in our article on the cost of a musculoskeletal disorder in the workplace

Workers Comp and TPAs: Lower Risk, Lower Cost

It’s not just the patient or the employer paying for a worker’s injury and recovery, it’s the company who took on the risk, as well. By digitally extending the reach of a third-party administrator, an injured worker can receive comprehensive, continuous care.

Workers’ Comp and Third Party Administrators have a lot riding on the success of the patient’s surgery, as a poor outcome can leave them on the hook for litigation. By helping to activate, engage, and track patient success, surgery optimization can help reduce litigation risk and, ultimately, costs.

Hospital Systems: Less Risk, More Success

Both regulators and executives have put increased focus on patient satisfaction in recent years. Part of offering value-based care, hospital systems serve to benefit from surgery optimization as well. Why? Because surgery optimization puts recovery in the hands of the patients and helps them to feel more involved. 

An involved patient is one who puts more effort into PreHab. A patient who puts more effort into PreHab is going to recover faster and feel more confident in the hospital that helped. This leads to positive reviews, better appearance to HHS and CMS, and could result in more revenue if you become the go-to facility for MSK treatment.

Payers: Smaller Hospital Bills for Patients Mean Smaller Bills for You

For the insured patient who wasn’t injured in a workplace injury, payers have a lot riding on a patient’s recovery and success. After all, patients are going to blow past their maximum out-of-pocket costs and at that point, it’s the payer who’s on the hook. 

Therefore, speedy patient recovery including fewer trips to physical therapy, lower risk of reinjury, and less need for skilled care is going to result in lower costs for the payers as well.

Surgery Optimization with PeerWell: Outcomes Delivered

An engaged, informed, and well-prepared patient is going to benefit, but it’s not just the patient who serves to gain from surgery optimization. Employers get their workers back, providers get better results, payers get to save money, and TPAs get to reduce risk. 

But remember, it all starts with the patient. When you arm them with the right tools, you’re helping yourself. Learn more about how PeerWell’s surgery optimization and avoidance technology is helping patients, payers and providers, like you.

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