Should You Add Total Joints?

When our surgery center launched its joint replacement program in 2017, we were the first freestanding ASC in Mass-achusetts to offer the procedures. Since then, interest in our program has grown among local surgeons and case volumes have steadily increased. This year, despite being shut down for several weeks during the COVID-19 outbreak, we'll perform between 100 and 150 procedures. We expect those numbers to continue to climb as more surgeons, insurers and patients learn more about the clinical and business benefits of sending joint replacement patients home the day of surgery. If you're thinking about taking part in the national movement of joint replacement cases to outpatient ORs, your answers to these key questions will determine if your facility is prepared to add the procedures.

Laying the foundation for success in outpatient total joints begins with working with interested surgeons who are committed to performing cases efficiently and have a proven track record of safety. The surgeons you partner with must also be willing to maintain a constant line of communication with patients and help guide them through the episode of care. They should expect to be more actively involved in all aspects of the patient's experience from the moment their cases are scheduled to the last post-op rehab appointment.

Joint replacement surgeons operating in acute care settings have not yet been able to experience the surgical efficiencies achieved in outpatient facilities that sports medicine and hand, foot and ankle surgeons have experienced for many years. ?They're beginning to realize they need to capitalize on the benefits of performing procedures in surgery centers, which offer dedicated surgical teams and the possibility of buying facility ownership shares. Outpatient joint replacement programs therefore help you recruit surgeons and grow your business with revenue-producing cases.

I recommend forming a multidisciplinary committee comprised of the providers and personnel — surgeons, anesthesia professionals, nurses, surgical techs, clinical managers and facility administrators — who will be involved in the joints program. Discuss all aspects of patient care and decide how you'll conduct staff education, select equipment and supply vendors and negotiate with insurers.

It's important to carve out the cost of pricey implants in the facility fee you negotiate with insurers. If possible, have surgeons agree to use implants from a single manufacturer. Establishing a standardized option will give you more buying power and help you negotiate a lower price.

Not long ago, vendors had doubts about the long-term feasibility of outpatient total joints. I've seen a shift in their thinking in recent months. Now, most vendors want to partner with facilities that perform one of outpatient surgery's hottest specialties and will offer very competitive implant pricing in exchange for a reasonable commitment of business.

Work with the committee of caregivers to map out the specific elements of your clinical pathway and present it to insurers to show how you plan to care for patients effectively and safely. Also establish clear and comprehensive discharge directives that help guide patients through their recoveries and post-op rehab routines.

We have a nurse navigator who manages the care of all total joint patients. ?She quarterbacks our facility's protocols and processes, and guides patients through the entire episode of care. In addition, we use a patient communication app to keep patients connected to their caregivers. The technology facilitates their compliance with pre- and post-op recovery protocols through automatically generated text or email alerts and reminders. It's been a great way to keep patients informed and satisfied with the care we provide.

Launching an outpatient joints program requires plenty of hard work, dedication and attention to detail, but you'll be rewarded with a service line that has tremendous growth potential. We obviously saw our case volume drop to zero during the COVID-19 outbreak, but now that elective procedures are back online, we've been contacted by new surgeons who are interested in moving their cases from hospitals to our facility. Moving forward, we believe every surgery center can benefit from surgeons who find the convenience and clean environment a welcome option for their patients during the pandemic and beyond. Now's the time to set your facility up to capitalize on that unexpected uptick in interest. OSM