In the next decade, up to half of all total joint replacements are expected to be performed in ASCs.
At Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference on June 15 in Chicago, Michael Chmell, MD, an orthopedic surgeon at OrthoIllinois Surgery Center in Rockford, Tammy Blackburn, RN, the OrthoIllinois Surgery Center director and Josh Christensen, the vice president of Smith & Nephew's ASC division, discussed total joint replacements in the ASC setting.
OrthoIllinois Surgery Center opened in 2004 and features four operating rooms, three of which are total joint capable; six preoperative and six recovery room beds; and no overnight capability. In 2017, surgeons performed over 3,915 cases at the ASC, an 8.5 percent increase over 2016, and 167 of those cases were total joint replacements, representing a 117 percent increase over 2015.
"If you're not doing total joints in your surgery center, there are a lot of reasons that you should be doing them," Dr. Chmell said. Patients benefit from being able to recover in their own home and face a decreased infection risk and fewer complications compared to a hospital setting, agreed the panelists. Surgeons and surgery centers benefit from increased ASC surgical volume, and the cost is significantly lower than if the procedure were performed at a hospital.
Here are four key points:
1. Payer negotiations. Dr. Chmell recommends surgery center owners looking to implement a total joint replacement program develop a protocol with a consistent team. Surgeons should start by performing outpatient joints at a hospital with the same anesthesiologist as at the ASC and using the same protocol to provide a track record when negotiating with insurers. He recommended the ASC manager, business manager, surgeon and anesthesiologist be in attendance for payer negotiations.
2. Supply chain management: The OrthoIllinois team learned that having a single vendor for total joint replacement implants helps for managing storage space and sterile processing. Having "custom packs for total joints saved our surgery center about 20 minutes per case in turnover," Ms. Blackburn said.
Smith & Nephew partnered with OrthoIllinois to build "a cross-franchise rebate structure that helped the center offset capital needs and strategic needs," Mr. Christensen said. This includes third party vendors as part of a structure to address additional needs.
3. Care coordination: OrthoIllinois recently hired nurse navigator who specifically works with total joint patients, performing risk assessments and monitoring patients' postoperative status, as well as arranging DME, home health, and pre- and postoperative physical therapy services.
4. Scheduling: Embrace creative scheduling to accommodate for cases. ASCs often schedule the more complex cases at the beginning of the day, allowing patients more time to recover before being discharged home. However, not every total joint case needs to be the first of the day.
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