THIS WEEK'S ARTICLES
Is Your Facility Really Ready for Total Joints?
Thoughts after three years from the first Massachusetts ASC to perform the procedures.
Joint replacements are proving to be a specialty with significant growth potential for ASCs. If you're considering adding the procedures or building a center for it, it's important to go into the project with a solid plan for clinical and financial success.
Boston Out-Patient Surgical Suites in Waltham, Mass., became the first freestanding ASC in the Bay State to offer total joint replacements back in 2017. The ASC has now successfully performed hundreds of the surgeries and is planning for continued growth.
Greg DeConciliis, PA-C, CASC, the facility's administrator, shares these tips on how to successfully enter the total joints market:
- Partner with the right surgeons. Mr. DeConciliis says a program's success depends on attracting surgeons who not only prioritize safety and efficiency, but are proven to have done so. They also should embrace and excel at communicating with patients throughout the entire episode of care. "They must be more actively involved in all aspects of the patient's experience from the moment cases are scheduled to the last post-op rehab appointment," he says.
- Develop a profitable model. Mr. DeConciliis says it's important to model your cost and reimbursement structure around the entire episode of care rather than the procedure itself. "Decide how you'll conduct staff education, select equipment and work with supply vendors," he says. "Carve out the cost of pricey implants in the facility fee you negotiate with insurers." Map the elements of your clinical pathway and present it to insurers to show how you plan to care for patients effectively and safely, he adds.
- Standardize supplies. Try to work with a single implant provider to simplify inventory management, boost your buying power and improve your ability to negotiate for better pricing. "I've seen a shift in their thinking," says Mr. DeConciliis of implant vendors battling for lucrative ASC business. "Now, most vendors will offer very competitive pricing in exchange for a reasonable commitment of business."
- Carefully screen patients. Base your patient selection protocols on the experience and comfort levels of your surgeons and anesthesia providers, recommends Mr. DeConciliis. "Many facilities, including ours, accept only patients with BMIs of less than 35 and ASA classification of 1 or 2, which by definition means they have very few comorbidities," he says. "We also try to avoid patients with sleep apnea, uncontrolled diabetes or bleeding disorders, those who smoke or have substance use disorders, and those who suffer from chronic pain management issues." Try to also assess a potential patient's self-motivation and support system, which can be very strong factors in successful outcomes.
When your joints program is up and running, have patients visit your center before their procedures to meet members of the care team, suggests Mr. DeConciliis. "Give them a tour of the facility so they know what to expect on the day of surgery," he says, extolling the visits' benefits in helping set patient expectations and communicating that they must be active, committed participants in their care to achieve optimal outcomes.
Orlando Health Goes Big With Build of Ortho Hospital
A 12-OR ASC will be included in the massive construction project.
Florida's Orlando Health is going big so its orthopedics patients can go home the day of surgery — or stay a while if necessary. It's all part of a 370,000-square-foot orthopedic medical complex currently under construction on the health system's main campus in downtown Orlando.
The Orlando Health Jewett Orthopedic Institute will be an eight-story, 75-bed specialty hospital with 10 inpatient surgery suites, numerous exam rooms and a medical pavilion, as well as a 12-OR ASC. The ASC will be housed on two floors of a six-story medical office building adjoining the inpatient hospital.
Billed as one of the only orthopedic-specific hospitals in the Southeast, it's slated to open in summer 2023. Orlando Health has revealed some interesting details about its plans for the ortho complex:
- The health system says the facility will offer "unparalleled comfort and ease for patients from arrival through departure." It claims the center will be so efficient that "wait times for patients will be virtually eliminated."
- An onsite diagnostic center will provide immediate results for physicians and patients.
- Patients will be able to access their health records, test results and schedules, and directly communicate with their providers, anytime and anywhere through a customized smartphone app Orlando Health will launch this year. The app can also be synchronized with a patient's fitness device to automatically update their EMR with data on their daily health habits and physical activity.
"We expect the Orlando Health Jewett Orthopedic Hospital will care for more patients upon opening than any other orthopedic facility in the Southeast," says Orlando Health President and CEO David Strong.
View the facility's recent construction kickoff event, featuring speeches by Orlando Health clinicians and administrators.
Stryker's Eight-step Approach Offers Unique, Tailored Solutions for Building and Expanding ASCs
Meeting the complex needs of ASCs to support their growth with flexible options and a customized process.
Over the past several years, procedural volumes, particularly with total joints, have been migrating from the hospital outpatient department to ambulatory surgery centers (ASCs) at an accelerated pace. With the potential to provide over $55 billion annually in healthcare cost savings in the U.S., this rapid shift in site of care is expected to continue over the next few years in the post-pandemic environment.
To meet the unique needs of this emerging customer, Stryker launched an ASC-focused business in mid-2020.
"By offering ASCs access to the breadth and depth of Stryker's portfolio, teams who understand the ASC landscape, and ongoing support to help build and grow their business, we are committed to delivering tailored solutions for ASCs to achieve their mission and goals," said Andy Pierce, Stryker's group president of MedSurg and Neurotechnology.
With thousands of unique products spanning more than 20 procedural specialties, and a wide range of flexible financial options, Stryker has positioned itself to meet the complex needs of ASCs while continuing to add value to healthcare.
Every ASC has a different mission and set of goals. The Stryker team starts by learning about each individual ASC. In the last 30 years, Stryker helped design and outfit over 15,000 operating rooms, and their broad product portfolio has the right equipment for every part of the ASC. As they work with customers, the team shares their expertise every step of the way and creates tailored solutions that help maximize clinical, financial and operational outcomes.
A Customized Eight-step Approach
With its new ASC business, Stryker has developed an eight-step process to offer ASCs access to a deep portfolio of products, guides who understand the ASC landscape and ongoing support that makes building and growing feel simple. The Stryker team's guidance and partnership, however, go well beyond a single purchase. As an ASC expands to new specialties, their team also helps business grow by conducting regular business reviews to help evaluate current usage and future needs; increases product efficiency and eliminates downtime with the ProCare service solutions; and provides customized, flexible financial options, ensuring the facility has the equipment and technology required to meet the needs of patients.
The first step of this eight-step process starts with Phase 1 at 24 months from opening a new ASC, and it entails the all-important Property Acquisition. While new construction may seem ideal for some, existing structures can often be retrofitted into highly-functional ASCs, and they tend to offer more flexibility in location in highly-developed areas.
In either case, Phase 2 is defining the Initial Project Scope, which Stryker defines as "right-sizing your facility from the very start" to achieve opportunities for future expansion. This important step occurs 20 months from opening and utilizes the company's market data and experience to make the right decisions for the specific facility being launched.
Choosing an architect may be the biggest single decision in the ASC design process. Stryker finds a partner who shares the vision using trusted partners who have ASC design experience. This Contracting an Architect step is Phase 3, and it is timed 18 months from opening.
Scheduled 14 months prior to opening is the Equipment and Budget Planning phase, which Stryker defines as Phase 4, and it requires strategies for financial flexibility. Smart financing options are the key to providing cash flow by balancing the initial investment with options and the flexibility to pay by procedure, choose leasing options or create a customized plan.
Next is the critical Room Layout Design and Clinical Specifications, Phase 5 and 6, which occurs 12 months from opening and goes to the heart of Stryker's products and capabilities. The company has been equipping operating rooms for almost 30 years and their broad product portfolio has the right equipment for every part of the ASC, providing value across the top specialties in the ASC setting including orthopedic surgery.
For the next steps, the Phase 7 and 8 execution begins 6 months before opening, and they involve the Construction Documents and Install as the final steps of an ASC construction or expansion. After months of careful planning, the Stryker team will help make sure that the final steps in ASC construction all go according to plan. Their network of trusted partners have experience fabricating operating rooms and installing Stryker's equipment as the building or renovating of the ASC takes final shape.
Learn more about Stryker's ASC-focused business: https://www.stryker.com/us/en/care-settings/asc.html
Get Ahead of Drug Shortages
A proactive approach helps maintain a full supply of medications.
Positioning a new or upgraded surgical facility for long-term success isn't just about shrewd capital equipment purchases, recruitment of great surgeons and staff, or effective strategies for growing patient volume. It's also about the more mundane task of ensuring your center's systems are built to maintain adequate levels of supplies, such as needed medications.
Some drugs and fluids used regularly in surgical facilities go in and out of shortage daily due to interruptions in the supply chain, a problem exacerbated by the pandemic, says Allen Vaida, PharmD, FASHP, executive vice president of the Institute for Safe Medication Practices (ISMP) in Horsham, Pa. For example, he points to shortages at various times of fentanyl, benzodiazepines, cardiac medications, diuretics, blood pressure meds, dextrose and saline fluids. "If your facility doesn't have protocols in place to plan for shortages before they occur, now is certainly the time to create them," he says.
Dr. Vaida suggests starting with these five steps:
- Monitor global supplies. Bookmark these sites and check them daily: The American Society of Health System Pharmacists (ASHP) current drug shortage list and the U.S. FDA drug shortage list. Dr. Vaida says these sites will help you assess current supply levels of your most-used medications as well as react to potential shortages before they impact your stock.
- Understand your inventory. Which medications are used for your most commonly performed procedures? Which do your surgeons and anesthesiologists prefer? Which replacements would they accept? Assemble this list and use it as the basis for your planning. "Maintain standard order sets (SOS) for your workhorse medications as well as for your facility's secondary and tertiary choices," says Dr. Vaida. "SOS are critical clinical tools that include dosage recommendations. Many medication errors occur when providers make dosing errors with drugs they're not used to administering."
- Plan workarounds. Do you usually administer a pain medication via IV before surgery, but availability is getting tight? Check if oral forms or prefilled syringes of the drug are available. Dr. Vaida reiterates that staff must understand how to properly administer any alternative medications that enter your facility before they are used.
- Leverage your relationships. Dr. Vaida suggests building a relationship with a 503B compounding pharmacy if you don't already have one. "Find out if they can compound medications on shortage from active pharmaceutical ingredients, a practice the FDA allows during shortages," he says. Another option is to contract directly with the pharmaceutical companies that make your workhorse medications, even if you generally obtain meds through wholesalers and distributors. "Direct contracts should be considered in this era during which shortages are the norm, because pharmaceutical companies can sometimes offer emergency allotments of medications that are on shortage," he says.
- Keep staff in the loop. Mention which drugs are on, or approaching, shortages during daily staff huddles. This is especially important to communicate to your surgeons, because your shortage might not be an issue at other facilities around town. . "Surgeons don't like inconsistencies or surprises, so keep them in the loop about shortages and your current medication inventories, says Dr. Vaida. "Maintaining open lines of communication with all stakeholders can prevent finger-pointing when a shortage invariably takes place."
Your ultimate goal should be to ensure that surgeries aren't postponed due to medication shortages. "An overall strategy of staying on top of pending shortages, keeping adequate inventories of your primary and replacement medications, and expanding relationships with suppliers will keep your facility nimble enough to ensure cases remain on the schedule, regardless of when shortages hit," says Dr. Vaida.
New business arrangement intends to appeal to GI doctors' independence as well as improve the patient experience.
Physician groups have founded and run many ASCs, but what about the other way around? One ASC management company, Physicians Endoscopy of Jamison, Pa., is trying it out.
The company has changed its brand to PE GI Solutions to more accurately reflect what it describes as its "holistic service model offering to GI specialists." The new name is the result of the company's move into practice management and development. A 2019 partnership with Capital Digestive Care, one of the largest GI groups in the country, led to the formation of PE's Practice Solutions platform to support and improve the performance of independent GI physicians and their practices. Practice Solutions is now integrated with PE's Center Solutions ASC management platform.
"The brand expansion takes us closer to the patients by being involved in the practice side as well, having the ability to provide GI physicians with support services to cover the spectrum of care from the practice to ancillary services, and all the way to ASCs," says PE President and CEO David Young.
According to PE, the Practice Solutions platform aligns GI physicians' business growth objectives through investment opportunities to improve and grow practices while maintaining physician independence. The PE Center Solutions platform addresses the development and management of freestanding, single-specialty endoscopic ASCs through aligned investments and collaboration with practicing physicians, health systems and hospitals.
"The shared service model is unique in that it is a holistic solution designed for the GI physician," says Mr. Young. "Through a series of strategies, it helps GI physicians run their businesses, remain independent and gain more time to focus on delivering quality care to patients."
Clinically speaking, the idea is to establish seamless, lifelong GI patient relationships. "When patients seek out PE GI Solutions-partnered practices and centers, they can expect to receive the most appropriate and efficient care throughout their entire patient journey," says the company.