Pro Tips to Set Up a New Ortho Center for Success

Experts share their strategies for smart equipment purchases.

Outfitting your orthopedic surgery center for the latest in cutting-edge procedures is an ongoing process, whether building from the ground up, retrofitting for growth or replacing end-of-life equipment. Experienced ASC leaders, through trial and error, have developed smart equipment purchasing strategies that save costs and conquer what can be a daunting process. Here, two such leaders offer tips on how to save money on equipment as well as what to avoid and when to consult with others for support.

Building from the ground up

Boston Out-Patient Surgical Suites in Waltham, Mass., is building a new facility to replace its current aging, smaller one. With 21 years in the business, Administrator Gregory P. DeConciliis, PA-C, CASC, knew exactly how to approach the project. He started by hiring an equipment procurement consultant to help him and his team organize the process, which he says is extremely difficult, even for experienced ASC leaders.

“The list of integrated, high-cost and time-consuming work to outfit a new ortho center is beyond one person,” says Mr. DeConciliis. For example, the task of writing product specs includes making sure each item will fit into its intended space and is near the appropriate power and water sources. There are also regulatory requirements to consider, surgeon preferences to accommodate and budget limitations that require savvy negotiations.

“There are literally hundreds of hours that will go into decisions surrounding your new facility,” he says. “If it’s one person handling many of these as the point person, the equipment coordinator is a must.” If a consultant isn’t in the budget, solicit help from the vendors, says Mr. DeConciliis.

“Selecting a vendor who can handle multiple equipment lines and products is a smart move, so it may make sense to work with one vendor primarily that can handle most of your needs,” he says. All major equipment companies have ASC divisions to assist with the process.

Tip: Don’t delay equipment selection. “There cannot be a mindset of ‘equipment is the last thing in’ because the architects, builders and subcontractors need the specifications of each piece of equipment early on,” says Mr. DeConciliis. “You’ve got to prioritize these decisions and deal with them in a timely, efficient fashion.”

Price optimization techniques

Kim Youman, RN, ASC director at Fox Valley Orthopedics in Geneva, Ill., oversees all purchasing for the physician-owned center that performs total joint replacements, spine fusions, arthroscopic sports medicine cases and more. With four ORs and more than 4,000 cases last year, business is booming. That’s why Ms. Youman is very strategic with equipment purchases, whether she’s negotiating prices with her go-to vendors, accommodating surgeon preferences or managing her extensive log of replacement costs for existing equipment.

Tip: Look for ways to spread out payments and secure bulk pricing. For example, as her stretchers neared the time for replacement, Ms. Youman secured a good price with a vendor for 20 new stretchers, but she’s paying for them two at a time throughout the year to avoid paying the full cost up front.

Ms. Youman also applies a smart costing approach for big purchases, such as when her center brought on a new surgeon who preferred a specific brand of robot and implants. “Securing the robot, the instruments and the implants represented a significant upfront cost,” she says. “Coordinating with the vendor and the surgeon, who already had an existing relationship, helped us get to a place where the cost was acceptable, and the surgeon was able to hit the ground running with scheduling cases here.”

Equipment purchases are only the beginning as you continue working with your surgeons to refine needs for optimizing procedures and keeping up with equipment maintenance and ongoing support, adds Ms. Youman.

Find long-term partners

Because Fox Valley Orthopedics is physician-owned, every provider has the ability to request their own preferred instrumentation. Ms. Youman works with three different vendors to accommodate the needs of her center’s four total joints surgeons. Tip: Standardize prices among different vendors. “This has been key to ensuring the projected revenue generated from total joint surgeries is spent on equipment in a financially responsible way,” she says.

Over the years, Ms. Youman has learned what to look for in a reliable vendor she wants to establish a long-term relationship with to ensure products and costs are optimized. Vendor qualities she looks for include trustworthiness and a willingness to have candid conversations about cost concerns and other issues. “I’m constantly on the phone with my vendors, and the ones I keep working with are those who answer my call and always work with me to find a solution,” she says.

Soliciting team feedback

Mr. DeConciliis recommends creating a small team of key equipment decision-makers, including representatives from each surgical specialty. This could include surgeons, nurses, surgical techs and financial personnel. The team should weigh their decisions toward patient care over the experience of the end-user, while considering costs. “Seek out individuals who are willing to put the time into this project,” he says.

Tip: Keep your circle small. Coordinate with vendors to organize product trials to solicit team feedback. “I ask my product selection committee members to document the reviews and feedback and organize it for me,” says Mr. DeConciliis. “The vendor supporting the product can do some of this work for you.”

DISRUPTION PREVENTION

Better OR Designs Make for Shorter Surgeries

THE BIG SHORT New research suggests efficiently designed operating rooms, like this outpatient orthopedic OR at Emory Musculoskeletal Institute, may reduce lengths of surgeries.

Disruptions in the OR make for longer cases, and poorly designed ORs cause disruptions. A University of Kansas professor decided to see if well-designed rooms would help.

They did, according to his study in HERD: Health Environments Research & Design Journal.

The study sought to learn which designs could shorten the length of orthopedic surgeries while increasing efficiency and patient safety. Recent research notes that lengthy surgeries are not only suboptimal themselves but can also result in cancelation of subsequent cases. They can also lead to postoperative complications, subpar patient experiences and an overall waste of healthcare resources. “The OR physical environment may play an important role in making health care leaner. It can contribute to the reduction of surgery duration by minimizing workflow disruptions and personnel movements during surgeries,” notes the study conducted by Associate Professor Xiaobo Quan, PhD, EDAC.

Dr. Quan observed 70 unilateral total knee or hip replacement surgeries performed by the same surgical team in two differently designed ORs at a community hospital in the Midwest. The duration of the surgeries, disruptions that occurred in the ORs’ environments and movements of the circulators in the perioperative teams were measured. “Significantly shorter surgery durations were recorded in the larger OR with more clearances on both sides of the operating table, a wider door located on the sidewall, more cabinets and more clearance between the circulator workstation and the sterile field,” concludes the study. “The better-designed OR was also associated with less frequent disruptions and fewer movements per case. Significant correlations existed between surgery duration, the number of disruptions and the number of movements.”

The research team encouraged more research and design innovations to optimize OR physical environments to achieve higher levels of safe and efficient delivery of surgical care.

— Adam Taylor

Room for growth

Ms. Youman is putting her vendor-collaboration skills to the test as her team plans to add two ORs. “We’re looking at robotics for outfitting new rooms, including fixed robots installed permanently,” she says. Fox Valley also plans to buy new imaging systems that can be incorporated directly into the ORs to align with the rooms’ functionality and space restrictions.

Plan for future service lines that would require additional providers at your practice. “We’ve added six new physicians in the last two years, and that’s part of our motivation to expand our space,” she says.

Tip: Weigh the costs and benefits of technology. Some rightly associate technology with higher cost, but it may provide added benefits such as safety and efficiency that warrant the price. “Don’t discount the advantage of the marketing ability of some technology, like a specific robot, when making that purchasing decision,” says Mr. DeConciliis. OSM