Andrew Stoeckl, MD
Partner
Excelsior Orthopaedics

David Uba, MBA
CEO
Excelsior Orthopaedics

Nicholas J. Violante, DO
Partner
Excelsior Orthopaedics

With a million patients getting knees and hips replaced at outpatient facilities each year and millions more expected to seek out the procedures in the coming years, now's the time to seriously consider adding total joints to your case mix. Excelsior Orthopaedics in Amherst, N.Y., recently completed its first year of replacing hips, knees and shoulders at its physician-owned surgery center. At OR Excellence during "Build a World-Class Outpatient Total Joints Program," a special 3-hour workshop on the conference's opening morning, business and clinical leaders from Excelsior will break down the keys to adding same-day joints, from selecting the right patients to managing recoveries to getting paid and profiting.

• Why now is the time. Patients who are seeking joint replacements are significantly younger and healthier than they were 10 or 15 years ago, says Andrew Stoeckl, MD. That, combined with the new economics of health care, has changed the philosophy on where joint replacements need to be done. Not every patient needs to have joints replaced in the hospital setting.
• A strong foundation. It's essential to have a physician leader who wants to make the program work, mostly because of the relationships needed between the surgeon and patients, who have to feel confident that they're not only going to have a great outcome, but that they're also going to have a comfortable and enjoyable experience, says Nicholas J. Violante, DO. Be sure to iron out all the clinical details in a controlled hospital setting before bringing cases to a surgery center setting. Once all of the tools and protocols are in place, the surgery should be the easiest part.
• Prudent patient selection. Interest is growing and case volume has the potential to increase, but that's a double-edged sword, says Dr. Stoeckl. Some of the patients who want same-day joint replacement aren't candidates to have it done. Approximately 15% of the patients he sees in clinic can have their procedures done in the surgery center. You must be honest with patients who don't qualify for having the procedure done in the same-day setting. A lot of boxes need to be checked, and the surgeon needs to trust his gut.
• On getting paid. You need to assess payers in your market to determine if they're ready to reimburse for total joints, says David Uba, MBA. Are they willing to look at different methodologies? Are they comfortable with bundled payments? Can they administer bundled payments? Do they have analytical capabilities that let them look at the cost of an episode of care and evaluate whether what you're proposing to them is going to save them money, improve outcomes and increase patient satisfaction? OSM