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By: Daniel Cook
Published: 2/19/2020
Taylor Cera, MBA, the chief operating officer at Youngstown (Ohio) Orthopaedic Associates, remembers enjoying eggs and toast on a lazy Saturday morning when his cellphone rattled on the table, alerting him to a message that would begin to test his building knowledge more than his business acumen. “One of our surgeons texted to tell me they wanted to start performing total joints,” says Mr. Cera.
That was back in 2015, when the surgeons Mr. Cera worked with leased operating space in a 3-OR surgery center. As demand for total joints steadily increased and interest in the program grew within the community, the surgeons decided they needed a space to call their own, where knee and hip replacement patients would receive world-class care in ORs outfitted with the latest surgical equipment.
Fast forward to present day. Mr. Cera is the administrator of The Orthopaedic Surgery Center in Boardman, Ohio, a $7 million, 4-OR orthopedic-centric facility that opened on New Year’s Day to accommodate the increasing number of joint replacements the surgeons performed: 50 hip, knee and shoulder replacements in 2015, 130 in 2019 and a projected 150 to 170 this year. Those numbers should only increase moving forward now that, after years of speculation, Medicare has added total knees to the list of payable ASC procedures. Total hips have been removed from the inpatient-only list and should soon join knees on the list of procedures approved for reimbursement at ASCs.
“Total joints are money-making procedures and insurers would rather pay our facility thousands of dollars less for the same procedures that cost $20,000 to $40,000 at the local hospital,” says Mr. Cera. “Insurance companies want low-cost, high-quality care, and patients want to undergo successful surgeries and recover at home. Outpatient total joints programs meet those needs.”
Richard Evans, MD, vice president of surgical services at Bon Secours Charity Health System and member of the Westchester (N.Y.) Medical Center Health Network, says his health system’s Good Samaritan Hospital built an ortho-only surgical facility to have a dedicated space where staff could focus on delivering care to total joints patients who, in turn, would benefit from single-specialty resources and a specialized staff’s expertise.
“Everyone has the same goal — achieving excellent outcomes,” says Dr. Evans. “Plenty of time to talk joints. Nurses all talk the same lingo and learn from each other about ways to improve patient care. Patients see other patients ambulating after undergoing the same procedures, and are motivated to do the same. That has a significant impact on positive surgical outcomes.”
Mr. Cera and Dr. Evans shared some of their facilities’ features that were designed to enhance joint replacement outcomes, and improve patient and staff satisfaction.
Determining how many ORs to build or frame out for future use is one of, if not the most, important decisions you’ll make. When you’re spending $450 per square foot, difficult decisions need to be made. It demands finding the sweet spot between forecasting future growth and working within the constraints of your current budget.
“Our new facility has 4 ORs, one more than we worked with previously,” says Mr. Cera. “Was it the right decision? We can’t be certain, but we’re currently working with more capacity than before and still have room to grow.”
The Orthopaedic Surgery Center also built its pre-op and PACU areas within steps of the ORs to limit the walking distance for staff and how far patients have to be moved from one location to the next. Good Samaritan’s waiting room was built close to the ORs, so surgeons can quickly shuttle between the spaces to update patient family members between cases. “Maintaining that efficient communication is important for everybody,” says Dr. Evans.
Both facilities added the latest advances in arthroscopy towers, 4K video technology and robotic arm-assisted technology, which is developing into a go-to tool for joint replacement surgeons that will set your facility apart from the competition and outfit it for the future of joint replacement care.
Streamlined facilities should build multi-use spaces to optimize efficiencies and maximize overall capacity. The Orthopaedic Surgery Center has 3 overnight suites used for a small percentage of 23-hour-stay patients who need extended recoveries. They can be closed off with private doors or kept open during busy days as extra PACU space.
The washers feature the latest cleaning technology with capacities 2 times larger than the models in the group’s previous facility. Each joint replacement sends 7 to 9 instrument trays to central sterile for reprocessing. The large-capacity washers help the reprocessing techs keep up with the heavy workload. “In an 8-hour day, the washers help us gain 3.25 hours of added efficiency,” says Mr. Cera.
The interior designer who worked on The Orthopaedic Surgery Center went for an “industrial sophistication” look, which features exposed ceilings and walls painted white, gray and light blue.
“A healthcare facility should reflect the local culture in order to connect with its patient population,” says Mr. Cera. “We designed the look of the facility based on the steel industrial culture that helped build towns here in northeast Ohio.”
One of the facility’s surgeon-owners came up with the mantra that guided the decision to build the new facility: responsible medicine, which involves reducing waste and providing safe, efficient care. Those guiding principles served as the facility’s foundation, both literally and figuratively. “Having complete control over the design and function of our surgery center helps us put those words into action,” says Mr. Cera. “We designed the facility to offer patients in our community access to premier outpatient orthopedic care.” OSM
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