Mechanical, not inflammatory.
A two-minute screener sorts the knee pain: mechanical OA, not an inflammatory arthritis — the right patient for a conservative-first pathway, not a straight-to-surgery referral. Routed accordingly.
She understands the options before anyone operates.
The knee-OA class — what the diagnosis means, what conservative care can and can’t do, when surgery is warranted — completed before a surgical decision. Informed, on the record.
Twelve weeks of conservative care — measured, not assumed.
Home-exercise RTM with a validated outcome captured at baseline and follow-up: KOOS-JR 42 → 44 after 12 weeks — minimal functional gain despite documented adherence. Conservative care given a fair, measured trial; now a surgical candidate on evidence, not a hunch. This is the PRO the value-based contract pays on.
The surgeon codes it — and an engine, not the model, checks it.
TKA performed. The op-note reads as 27447; the model proposes the codes and quotes the supporting line, then the deterministic CMS NCCI engine checks each one — the model does not grade its own work — and the surgeon signs. One code came back a caution to resolve before submission.
Five steps. Four receipts. One episode record.
Nothing above lives in a silo. Each step emitted a receipt — what was proposed, what external source verified it, who signed, and a hash that seals it — and they chain into a single longitudinal record of the whole episode, from first symptom to final code.
The model read; an external check said yes or no at every step; a named human signed; a hash made it tamper-evident. PHI never left the record — the proof travels, the note stays home.
The party at risk for the whole episode.
Not the surgeon (buys coding) or the PT (buys tracking). The risk-bearing entity — the ACO, the ACCESS participant, the bundle-holder, the provider-owned plan — is the only one who needs the entire record:
- ✓The right patient reached surgery — the wrong ones were measured and diverted, not operated on.
- ✓The outcome the value-based contract scores on was captured, not assumed.
- ✓Every code is defensible — engine-checked, human-signed, RADV/RAC-survivable.
- ✓It compounds: the more episodes run, the more the record is worth — and no one holding a commodity model holds it.
This is the harness, walked end to end.
The homepage shows the network. This shows one patient moving through it — every output seen, every signer controlled, the whole audit trail owned. Where does that check live in your stack?