Be organized and thorough, and don’t move too quickly.
To create world-class total joint replacement programs with the most favorable outcomes for patients, outpatient surgery centers must consider a variety of factors to achieve success. Here are some key elements of adding this increasingly popular same-day service line.
Surgeon buy-in. “You have to start with the surgeon or a team of surgeons who are going to be champions and are really motivated to move their patients to an outpatient setting for multiple reasons,” says total hip and knee specialist Joseph Nessler, MD, an orthopedic surgeon at St. Cloud (Minn.) Surgery Center. “When you’re first starting up, it takes a lot of effort and input from your physicians to make sure everyone is on the same page.”
Staff buy-in. Every level of your center, from nurses to therapists to the critical schedulers and administrative staff, must be engaged for a same-day total joints line to operate like a well-oiled machine. You’ll want their help to standardize the surgical process from start to finish, extending to areas such as procedure scheduling, patient education and post-op recovery. “Staff must be aligned and experienced,” says Gregory DeConciliis, PA-C, CASC, administrator at Boston Out-Patient Surgical Suites in Waltham, Mass. “Success comes from proper planning and really outlining what your programs will look like from taking a patient to pre-op all the way to post-op.”
Protocols. “Get everyone in the same room — anesthesia, nursing, techs, pre-op, surgeons and even PT — to discuss how you’re going to do it and develop pre-op criteria and admittance criteria,” says Mr. DeConciliis. He suggests that when the line is first activated, the same staffers perform pre-established roles for multiple procedures. “It was helpful for us to have the same personnel deal with the patients when we started,” he says. “Early on, consistency was essential. Along the way, we developed protocols and preferences that helped us train other staff as we brought them on.”
Dr. Nessler takes this concept a step further: Only staff who have been specifically trained on performing total joints procedures are allowed in his ORs. “Staff aren’t allowed to scrub in unless they’re on the total joints team,” says Dr. Nessler. “This protocol decreases turnaround time and the time spent on the procedure, since everyone knows what to look for.”
Resources. “Look at your facility and make sure your ORs are going to be an adequate size with the proper configuration to do total joints,” says Dr. Nessler. “Many facilities have failed to fully factor in the impact of space constraints prior to starting up a program.” Your plan should account for any physical expansion you’ll need down the line and equipment that must be purchased, including additional purchases such as washers and sterilizers you might need in your sterile processing department.
Start small and conservatively. Ease into your launch by focusing on patients who have the fewest comorbidities. “Be careful not to ramp up too quickly,” says Mr. DeConciliis. “Try not to deviate from your patient selection criteria too quickly. Hit the home runs early on. As your staff get more experienced, you can expand and start caring for more complicated patients.”
Cost-benefit analysis. Certain technologies, implants and medications may seem pricey in the short-term, but ultimately may help you achieve significant cost savings down the line, especially if they could potentially improve patient outcomes. “Be open to exploring the use of higher-cost drugs and devices that may enhance patients’ experience and recovery,” says Mr. DeConciliis. “There are certain things you can spend money on, and the benefits come back to you tenfold.”
Negotiate with payers. “Bundled contracts are helpful,” says Dr. Nessler. “Contracting with the insurers can ensure you’ll get an adequate price to cover your costs. Get ahead of the game and negotiate those things as soon as possible.” Since outpatient costs of joint replacements are already significantly lower than in hospital settings, ASCs can leverage that advantage in negotiations.
Constantly refine. Regularly monitoring and reviewing your total joints protocols and outcomes is vital to continued success. “We meet about the program on a frequent basis to look at any deviations from the normal, and try to learn from it and improve,” says Mr. DeConciliis. “You’ll need to revisit it to see how things are going and make improvements.” OSM
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Twin Cities Orthopedics 
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