MAKING A CHANGE Many surgeons are taking their total joint procedures to outpatient settings.

If building a total joints program from the ground up sounds incredibly challenging, well, that's because it is. But the rewards will likely be well worth the blood, sweat and tears you'll shed. Not only are total joints exploding, but increasingly they're being performed in outpatient facilities: a more efficient, a more economical and a more desirable setting for surgeons as well as for patients — who'd much prefer to recover and rehabilitate at home rather than spend 3 nights in a hospital.

The numbers tell the story. About 3 million patients are expected to undergo outpatient hip and knee replacements by 2030. Already, more than 10% of total knee cases and being performed on an outpatient basis — a number expected to grow when Medicare begins paying for hip and knee replacement surgeries that are performed in ambulatory surgical centers, which could happen as early as this month when CMS unveils the final 2018 outpatient payment rule.

If you'd like to capitalize on this opportunity and add total joints to your facility, you don't have to go it alone. Many of the leading orthopedic implant companies offer programs to support your facility through the transition. We talked to 5 of them and distilled how they can help you.

1. Educate your surgeons and staff
Starting the process of implementing outpatient total joints at your facility begins with educating yourself and your staff on the nuts and bolts, but where do you begin? How to choose a good candidate for outpatient surgery — one who has no significant comorbidities like sleep apnea or diabetes — and how to consult with the patient and family before and after the surgery are some basic lessons you need to learn, says William Wilder, director of outpatient marketing for DePuy Synthes.

DePuy's free program, called Outpatient Pathways, "provides the playbook to help surgeons, nurses and ASC administrators," says Mr. Wilder. The program, led by a pioneer faculty, is broken down into 3 chapters: How to Get Started, Operational Checklist and Patient Checklist.

DePuy, which has trained more than 1,200 healthcare professionals since 2014, offers a variety of learning opportunities. You can take a national course on outpatient total joint surgeries or speak one-on-one on the phone with surgeons who have conducted several outpatient joint surgeries already. "Surgeons want to learn from their peers," says Mr. Wilder.

Smith & Nephew takes a similar approach. Its Short Stay Total Joint Program offers "technologies and education to assist with onboarding of total joint replacement." It also offers a webinar by Mark Snyder, MD, director of the Orthopaedic Center of Excellence at Good Samaritan Hospital in Cincinnati, Ohio, titled, Best Practices for Pre, Peri and Post-Op Care of the Short Stay Joint Replacement Patient.

2. Coordinate site visits to other total joint facilities
Nothing opens your eyes like seeing what's involved for yourself. DePuy Synthes and Arthrex are among the companies that set up site visits to up-and-running joint programs so facility leaders can see firsthand how the process works.

David Uba, MBA, CEO of Excelsior Orthopedics in Amherst, N.Y., recalls going to a surgery center in Columbus, Ohio, under the guidance of DePuy Synthes, and spending the day with surgeons and the administrative team. He was able to get a feel for how the personnel worked together in the surgical center to make sure the patient was ready to leave by the end of the day, says Mr. Uba.

Arthrex invites a party of 4 — generally a surgeon, administrator, member of the nursing department and an anesthesiologist — from the facility interested in adding a program to spend a day in a surgery center, says Steve Schewe, director of global arthroplasty business development for Arthrex.

Each visitor spends the day shadowing his or her corresponding peer, watching how the other works, sets up patients, gives advice to family members and fills out paperwork for payers, says Mr. Schewe. What makes the biggest impact? Almost always, visitors expect only large facilities to be able to handle outpatient total joint procedures and are shocked at just how much one small surgical facility can handle, says Mr. Schewe.

"Typically, the group leaves motivated — and they also realize how much work it is," says Mr. Schewe.

3. Develop a marketing strategy
Most patients are still unaware that they can go to an outpatient facility for joint replacement surgery, says John Walters, senior director for Zimmer Biomet Signature Solutions' Outpatient Program. When you sign up, you pay for different services, each of which gives you and your facility support as you start implementing outpatient total joint procedures. One of the services offered is help getting the word about the procedure out to patients, says Mr. Walters. A marketing team sits down with your facility to help design a plan for patient awareness. That includes anything from newspaper and radio ads, to seminars, to sometimes even a billboard, that promotes your facility for outpatient total joint care, says Mr. Walters.

"The goal is to let people know outpatient total joint surgery is possible," he says.

Medtronic provides similar help on this front. It has a generic marketing template, which facilities can use to advertise their program. All your facility has to do is add your logo and print it out.

"It's up to (the facilities) to leverage that," says Elaine Sebak, Medtronic's senior manager of marketing development.

4. Map out surgical workflow
Some companies will help your facility form a step-by-step plan for the day of surgery. Zimmer Biomet does this by sending specialists to sit down with members of your facility. They'll ask you questions to gauge, among other things, how comfortable your facility is with quick patient turnaround, how long your surgeon takes to complete a procedure, how large your facility is and how many patients you can accommodate, says Mr. Walters.

All of these questions can help specialists pinpoint what areas of the outpatient process they should focus on as they help lay out a day-of-surgery schedule.

"We're trying to change the habit of how they've been doing things," says Mr. Walters.

Medtronic takes a slightly different approach to helping you plan out your facility's workflow. In its program, which it charges for, the company sends staff and surgeon advisors to help implement day-to-day protocols in your facility as you gear up to host outpatient total joint procedures. Surgeons are asked to sign "commitment" contracts, stating the facility will use Medtronic's Radius360 consulting program for a set number of years, typically 2, says the company.

"Within that time, you're able to establish the right criteria and protocols," says Adam King, vice president of orthopedic solutions for Medtronic.

HELPING HAND FROM VENDORS
Total Joint Assistance Programs

From connecting your surgeons with mentors to mapping out the day of surgery, these are a few of the leading orthopedic companies that offer programs to help you launch a total joint program. Some programs are free and there's a fee for others, but they all aim to help you and your surgeons prepare to offer outpatient total joint procedures.

• Arthrex provides free education and site visits. For all other consulting services, they contract with a company called "Convergent."
  arthrex.com
• DePuy Synthes's free "Outpatient Pathway" program provides education and organizes site visits to outpatient joint replacement programs.
  depuysynthes.com/asc/total-joints-in-the-asc
• Medtronic's "Radius360" helps with total joint planning, marketing and education.
  medtronic.com
• Smith & Nephew offers a free program called, "Short Stay Total Joint Program," which helps with education and managing your workflow.
  smith-nephew.com/professional/asc/asc-program
• Zimmer Biomet's "Outpatient Program" helps with education, workflow management and patient communication.
  zimmerbiometsignaturesolutions.com/outpatient

5. Send patients pre- and post-op texts
A total joint patient is in your facility for only a matter of hours, but what the patient does beforehand to prepare for surgery and after during recovery and rehab is critical to the success of your program. Text message reminders certainly help keep patients on the right track.

Zimmer Biomet lets you send out automatic messages to patients, reminding them to prepare for the day of surgery. You can also send automatic messages following surgery to remind your patients to complete their physical therapy properly. (Physical therapists say most patients do only about 25% of their prescribed exercises following a surgical procedure, says Mr. Walters.)

The texts "give patients the feeling that their care team is watching them," which holds them accountable and improves compliance, says Mr. Walters. OSM