On Point: Exciting Opportunities in Orthopedics

I've always been a big believer in the potential of performing complex joint procedures on an outpatient basis. I performed my first outpatient total hip 20 years ago, and I was the first one in the world to do it. I did my first outpatient knee replacement 18 years ago. Since then, I've done more than 11,000 outpatient joint replacement procedures, and I've seen plenty of changes in the industry during that time. One of these changes is occurring as we speak. Patients today are less worried about going to a surgery center for orthopedic procedures, be it a total joint replacement or a shoulder arthroscopy. In fact, in many cases, patients actually prefer it. The COVID-19 pandemic has certainly played a role in this shift. Patients who opt for elective surgery want to avoid hospital stays and, in many cases, hospitals overrun with coronavirus patients are moving procedures they may have handled inpatient pre-pandemic to the outpatient realm for safety or resource-related issues.

Of course, there will always be a need for both large hospitals and small standalone surgery centers. However, right now, the latter is better positioned to meet the complex surgical needs and patient care requirements of the COVID-19 era. When we got the green light to restart elective surgeries after the nationwide shutdown earlier this year, our health system's surgery centers opened first because it was much easier for focused staff to get the extra safety measures up and running. That's understandable. If you're a 20-employee surgery center, you can be nimbler than you can at a medical center that employs thousands of people and needs time to incorporate even the smallest changes into its vast infrastructure. Still, regardless of whether you're operating a freestanding ASC or the HOPD at a major medical center, there are exciting opportunities for you and your patients in orthopedics.

A joint replacement is a 'get out of jail free card'for people who have been imprisoned by a debilitating condition.
— Richard A. Berger, MD

• Surgery must go on. Facility leaders need to encourage patients not to forgo care they desperately need just because the surgery is technically labeled "elective," which is a misleading term. As we enter into the fall, the COVID-19 pandemic will probably get worse before it gets better. Think back to when we were first asked to shelter in place. How did you feel? Like your freedom was taken away, right? For patients with arthritis, that is their reality every day. They have to stay inside. They can't get around. They can't do anything, really. They are being quarantined by a condition that has slowly taken away everything they love. We can fix that for them. A joint replacement is a "get out of jail free card" for people who have been imprisoned by a debilitating condition. In most cases, surgery shouldn't be put off simply because of this pandemic. Outpatient facilities can still offer safe, effective and life-changing care in the face of COVID-19. In fact, there is nothing safer than coming to one of my surgery centers to get your total joint replacement done. We've been following universal precautions for years, and now we have heightened those precautions.
• Value-based care. Bundled payment structures have been getting a lot of buzz in recent years, and that makes sense. But these arrangements don't work for every facility. For instance, if you're at a big institution with high overhead, everything simply costs more. However, for certain outpatient facilities — particularly smaller surgery centers — bundled payment structures are a great option. They offer insurance companies or Medicare the ability to decrease costs, and they give facilities the ability to take ownership in providing high-level care at a much-reduced rate.
• Improved customization. Orthopedic manufacturers have made great strides in the design of implants that are a better fit for patients, anatomically speaking. Case in point: gender-specific knees. Historically, knee implants have been designed for men. The thinking was, "If it's strong enough for a man, it can be used for women, too." That's simply not the case. A woman's knee is not only a different size, but also a different shape. There are slightly different contours and angles, and gender-specific knees account for those differences. When you consider that two-thirds of knee replacements are done in women, the ability to offer a gender-specific option will easily set the facilities that offer it apart from the competition.

COVID-19 is likely to expedite an already increased demand for complex outpatient orthopedic procedures — such as total hips, knees and even shoulders — and you no doubt want your facility to be ready to capitalize on these opportunities. However, while the business aspect is certainly important, we must always remember our top priority is to take proper care of patients.

Whether you plan to start a total joints program for the first time or expand on a current one, make sure you have a well thought-out, well-planned and well-executed strategy that provides a superior patient experience at every stage of the care continuum. If you can guarantee these things, your orthopedic service line will thrive. OSM