Prior to COVID-19, experts predicted that by 2025, as many as half of all total joint procedures would be performed in the ambulatory surgery center (ASC) setting. The pandemic, however, has accelerated the movement of patients from hospitals to ASCs. This surge in growth has created new demands for ASC leaders, as payers demand better data and value-based care models focus on the entire episode of patient care.
Becker’s ASC Review recently spoke with Laura Rector, Vice President of ASC Solutions at Smith+Nephew, to learn more about the current ASC environment and how digital health solutions can help address many of the most significant issues facing ASC leaders.
ASCs need data to navigate new challenges — and digital health solutions can help
With increasing patient volumes, ASCs are quickly realizing that better data collection is key to improving efficiency, boosting profitability and tracking outcomes more effectively. Healthcare is becoming more transparent and many payers expect clinical and cost data to be readily available from providers. Actively collecting data helps ASCs manage costs, improve compliance and manage commercial bundles with greater success.
“When I joined Smith+Nephew, it was clear digital health would be the future for ASCs, specifically in orthopedics,” Ms. Rector said. “Understanding costs, working with payers and negotiating bundles based on data are important. Digital health is the solution for all of that.”
Most ASCs are run by independent owner-leaders and surgeons. In the past, surgeons working in the hospital setting weren’t responsible for the connected delivery of care throughout a patient’s clinical episode. Focusing on the complete episode of care for ASC patients is often a new mindset. Fortunately, Smith+Nephew’s ARIA digital patient management platform can help with this adjustment. The system is designed specifically to help ASCs and surgeons manage data collection and operations.
“ASCs must become familiar with managing patients from first pain to full recovery. They need to connect the entire episode of care,” Ms. Rector explained. “ARIA is a flexible and easy-to-use web-based platform that enhances the overall patient experience, so people can get back to their dreams and goals and live a life unlimited. That’s the goal of digital healthcare and ARIA does a lot of things to enable that.”
Another big concern for ASC leaders is selecting the right patient for outpatient care. Although payers are highly motivated to move patients to the ASC setting because the cost profile is 40 percent lower than in the hospital setting, not all patients are appropriate candidates for an ambulatory surgery center. In a world of bundled care, patients with multiple risk factors can translate into more costly procedures and lower profitability for the ASC.
“With the ARIA digital platform, we can help physicians pre-qualify patients for the appropriate site of care,” Ms. Rector said. “An algorithm analyzes multiple patient factors and makes a recommendation about whether a patient will do well with an ASC procedure. This gives surgeons objective, clinical decision-making support tool during the selection process.”
After adopting ARIA, surgeons have seen positive results. Compared to home nursing or inpatient rehab, ARIA users reported a 45 percent reduction in readmission rates through patient progress and evaluation, a 35 percent reduction in 90-day episodic costs and a 30 percent reduction in length of stay in skilled nursing facilities.
With total joint procedures, physical therapy plays a central role in the end-to-end episode of care
Physical therapy is a critical part of the recovery process after a number of surgical procedures. However, the post- surgical care process can often feel a bit disjointed. After surgery, patients and caregivers are usually given a follow-up appointment and a few sheets of paper that outline care guidelines. Then the daunting process of physical therapy begins.
“A lot of times, depending on the procedure, patients can’t transport themselves to physical therapy,” Ms. Rector said. “Driving to appointments and the whole recovery process becomes a family affair. ARIA Home PT works with a physical therapist to support their efforts while letting patients engage on their time, in their homes and supports a patient’s journey back to life unlimited.”
ARIA Home PT is a self-contained, tabletop device that is delivered straight to the patient’s home and is picked up after the physical therapy program has concluded. A digital avatar guides patients through exercises on a large touchscreen and the device offers a library of instructional exercise videos as well as reminders for patients to complete their rehab. A 3D-camera captures movements, counts exercise reps and alerts users when they perform movements incorrectly. Patients can also meet virtually with a licensed physical therapist who monitors their progress remotely.
Patients enjoy the home PT experience, giving ARIA Home PT a 90.3 Net Promoter Score (scores higher than 70 are considered world-class). Home-based, digitally delivered physical therapy also can generate meaningful cost savings. A prospective, multicenter randomized controlled trial showed that ARIA Home PT saved $2,475 per patient compared to traditional PT care in the home or in an outpatient clinic.
With value-based care, the goal is to get patients the best outcomes at the lowest cost. Smith+Nephew is also looking at the role physical therapy can play in "pre-hab" for patients who may need orthopedic surgery. In some cases, compliance with pre-care physical therapy can help patients avoid knee or hip surgery if they have muscular, rather than structural, issues.
To derive maximum value from digital health solutions, ASCs must focus on both the technology and implementation
Successful ASCs recognize it’s not enough to simply select a digital health solution; they also need to focus on the implementation details. Smith+Nephew has a dedicated ASC team that collaborates with surgeons and ASC owners to optimize the complete episode of care, from pre-care all the way through to full recovery. This includes implementing the ARIA digital care platform, moving into robotically assisted surgery and more.
“A surgeon may want to move cases to the ASC to provide a better patient experience, lower the cost of care and enjoy greater autonomy over procedures,” Ms. Rector said. “Making the jump from the hospital to the ASC isn’t always easy, however. Our team can provide the training and education needed to make that transition a smooth one.”
Once an ASC adopts a new digital solution, such as ARIA, the Smith+Nephew implementation team helps to customize the tools, facilitate handoffs between employees and create the right user experience for each organization.
“Our clinical team collaborates with users to plan, build and train for a successful program,” Ms. Rector said. “We have local, dedicated account managers nationwide who work with customers throughout the entire journey. It’s very coordinated. At every stage of the process, people are there to guide surgeons towards success.”