Inspiring Advances in Sports Medicine

Navigating the fast lane of ASC-based surgical care.

In the ever-evolving landscape of outpatient surgery, sports medicine stands out as a dynamic and promising field. ASC leaders who embrace innovative techniques, cutting-edge equipment and strategic approaches are finding success getting active adults back on their feet quickly and efficiently. Here are some of the best ways to enhance sports medicine procedures at your ASC.

State-of-the-art equipment

The cornerstone of any successful sports medicine program in an ASC is state-of-the-art equipment. According to Corey Troxell, DO, MBA, a surgeon at Lancaster (Pa.) Orthopedic Group, several technologies are employed at its ASC (The LOG Surgery Center) to elevate sports medicine procedures and enhance patient outcomes. The center, inaugurated in the fall of 2022, specializes in traditional cases but is gearing up for higher acuity cases, including joint replacements and spine surgery.

One key feature of its efficiency is its use of an electronic medical record platform, ensuring seamless coordination between the office and surgery center. Utilizing electronic health records and data analytics allows for the tracking of outcomes, patient satisfaction and operational efficiency. This data-driven approach enables leaders to identify areas for improvement, refine protocols and ultimately enhance the overall quality of care.

“That’s not something that’s always seen in a surgery center,” says Dr. Troxell. “It’s the same one we use in our offices, and it really helps with sharing information efficiently back and forth to the office from the center.”

Dr. Troxell also highlights the importance of cutting-edge arthroscopy equipment, including a high-quality 4K camera and top-notch scopes. For today’s arthroscopy procedures, top-tier visualization is typically recognized as 4K resolution — a fourfold increase over standard HD, providing superior color reproduction. “You really need high-quality images to see the surgical field more efficiently and effectively,” he says. “For the center, we wanted to get the highest quality camera and scopes.”

While the LOG Surgery Center opted for a 4K arthroscopy system, Dr. Troxell notes that not only was ensuring the equipment was good “out of the box” a priority, but also that it came with the support the center needed for its long-term use.

“You need to have a good contract in place, especially in a high-volume center,” he says. “These systems can wear out or get damaged, and you need to have a strong maintenance contract to make sure the equipment is serviced to keep it at the high-level quality it was when you initially purchased it.”

New technologies also can mean new challenges, especially when it comes to reimbursements. Negotiating contracts with private payors for reimbursement, particularly for costly sports medicine implants like the latest suture anchors and biologic grafts, is a crucial aspect of overcoming financial hurdles.

“As the implants for sports medicine have improved, they’ve gotten more costly,” says Dr. Troxell. “You can get more contracts with private payors and try to break even on the cost of those implants.”

And as the trends of biologic augmentation and restorative procedures continues to grow, the center has looked for ways to best incorporate those methods into cases. Dr. Troxell notes that currently, the center performs platelet-rich plasma and bone marrow aspirate injections for procedures like rotator cuff and ACL repairs, while also performing the harvest surgery for cartilage restoration. With this, the surgeon harvests the patient’s own articular cartilage, which is then sent to a lab where it is treated to grow additional cartilage cells on an implant. From there, it is then sent back to the surgeon to implant in the patient.

“You’re going to see more and more involvement in biologic augmentation and restorative procedures, like restoring articular cartilage,” says Dr. Troxell. “These are advancing, with the science evolving. Augmenting with platelet-rich plasma, bone marrow aspirate injections, stem cell injections — these techniques are enhancing repairs and reconstructions to improve biology for healing, speed up the recovery process, and potentially expand restorative procedures for localized injuries or defects of articular cartilage.

“While some have been limited in the ASC space due to cost, I believe payors will increasingly work to integrate these advancements into surgery center world because of their potential benefits,” he added. Finally, with his center progressing into joint replacements, Dr. Troxell also notes the facility’s plan to incorporate robotics for hip and knee procedures.

“One of the major technological advances we’re looking at, as we roll out the joint replacement program, is robotics,” says Dr. Troxell. “But it’s important to make sure you really have the volume there before you bring in the robotic platform, especially with their associated high costs.”

Seen and Screened for Just 15 Beans

QUICK CHECK Dave Grinnell, a physical therapist and board-certified clinical specialist in orthopedics at UCHealth SportsMed Clinic in Steamboat Springs, Colo., assesses a patient’s knee pain during a $15 injury screening.

What began as a way to encourage community members to meet UCHealth SportsMed Clinic therapists and receive a home program has, since the clinic became a direct access provider, morphed into a popular way for un/underinsured and those with high deductible plans to get their injuries assessed for a very reasonable price of $15, says Mary Beth Strotbeck, MTP, manager of the Steamboat Springs, Colo.-based Clinic. Ms. Strotbeck says the screenings consist of a patient meeting with a physical therapist for a full assessment of the injury to establish the root cause of their pain or discomfort. Through conversation and a physical assessment, the physical therapist can explain the extent of the injury, provide education to the patient and suggest any possible next steps. “These next steps can include exercises or stretches for management of the injury at home, or a recommendation to seek additional care from a physician or orthopedic specialist,” she says, adding, “injury screenings are a great way for individuals to connect with a physical therapist to better understand the extent of their injury in a cost-effective way.”

— Outpatient Surgery Editors

Specialized staffing

The success of a sports medicine program hinges on the expertise of the entire medical team. ASC leaders are recognizing the importance of assembling a specialized staff with experience in sports-related injuries and procedures. Staff training is a multifaceted approach, incorporating familiarization with equipment for the OR staff and comprehensive pre-surgical education for patients, says Dr. Troxell.

“There is a ton of pre-surgical education and planning to make sure that the patient has the right expectations and the knowledge of the procedure,” he says. “We work with our staff and partners to make sure that everything the patient needs is set up — post-op physical therapy appointments, their medications, etc.”

When it comes to incorporating higher acuity cases, the center also ensures staff have the training to prioritize safety in discharging patients, ensuring they are physically capable of mobility before leaving the facility. He notes that the center is currently training PACU nurses specifically on things like making sure a patient can walk safely with a walker prior to discharge.

All this continuing education builds upon the staff’s prior knowledge of sports medicine, which has made a huge difference in the overall workflow of the center, says Dr. Troxell.

“These are the teams that we built, and they are only doing orthopedics day to day at the facility,” he adds. “That in and of itself creates an efficiency in the center.”

The ASC also focuses intensely on team-building and culture, instituting daily huddles that allow staff to bring forward any thoughts or concerns to the team at large.

You’re going to see more and more involvement in biologic augmentation and restorative procedures, like restoring articular cartilage.
Corey Troxell, DO, MBA

“Team-building can go a long way to improve efficiency,” says Dr. Troxell. “All the way from check-in to pre-op to the OR to the recovery room, we want staff to feel like they have some pride and stake in the game. If we get that buy-in, we have a solid team. If you build a culture where people like to work, it inherently creates efficiency and makes everyone’s day better.”

Patient-centric approach

A patient-centric approach is at the heart of successful sports medicine in ASCs. From the moment a patient walks through the door, the focus is on delivering personalized care that addresses their unique needs and goals. Patient education plays a pivotal role, empowering individuals to actively participate in their recovery and preventive measures.

Dr. Troxell outlines the patient journey within the ASC, emphasizing the thoughtful design of the facility for a smooth flow from pre-op to post-op. This architectural consideration, along with an efficient workflow, minimizes the need for excessive movement within the facility, enhancing convenience for both patients and staff.

“Patient experience is huge for us,” says Dr. Troxell. “I always try to remember that when we’re going to a surgery, it’s just another day of work. But when a patient is going to surgery, it’s a pretty big day of their life. Most don’t have that many surgeries in their lifetime. It can be pretty nerve-wracking. We try to have a comfortable environment, welcoming staff and ensure them we’re taking the best care of them while they’re there.”

For patients, that means starting with a nice, comfortable waiting area, including a place for refreshments for waiting family members. From there, they move into a private pre-op area, where they are checked in with the nursing staff and get their intake complete, start IVs and meet with anesthesia and the surgeon. They move back through the ORs, and when the procedure is finished, they head directly to a nearby post-op waiting area.

“This works great for the surgeon, too,” says Dr. Troxell. “We have dictation in the middle of that, and there’s a place for consultation with the family. There’s not a lot of running around from area to area — it’s all in the same vicinity and makes sense.”

The center’s strategic planning also positions it to embrace future trends — like its plans to begin total joints and spinal procedures soon — ensuring it continues to provide the best value for patients while contributing to the evolution of sports medicine in ASCs.

“The trend is going to be higher acuity cases moving to the ASC world,” says Dr. Troxell. “I think moving these higher acuity cases is going to be a huge step to help control healthcare costs. Not all patients are a candidate for an ASC surgery, and each patient needs to be selected on a case-by-case basis, with the proper risk stratification to make sure they’re appropriate for that facility. But you’re going to continue to see more and more higher-level cases being done in these sports medicine centers.” OSM