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Total Joints: Prime Opportunity for New ASC Procedures & Revenue

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At the 12th Annual Spine, Orthopedic and Pain Management Driven ASC Conference in Chicago on June 12, Julie Bell, administrator of Surgical Care Affiliates' Hawthorn Surgery Center, and Cindy Armistead, administrator of Campbell Clinic Surgery Center, discussed total joints in the ambulatory surgery center in a session moderated by Melissa Szabad, JD, a partner with McGuireWoods.

Hawthorn Surgery Center in Libertyville, Ill., is gearing up to perform its first total joint case within the next month and Campbell Clinic Surgery Center in Germantown, Tenn., has been performing total joints for a year.

Starting the discussion
Hawthorn Surgery Center recently opened in a new location, which doubles the size of its original facility. Ms. Bell and the center's 12 orthopedic surgeons realized the potential for increased volume and saw the most opportunity in total joints. Ms. Campbell and her team observed the growing trend of adult arthritis, a major driver behind total joint replacement. "Adult arthritis is expected to increase 45 percent in the next few years and we have seen that the age of those patients is dropping," says Ms. Armistead. The ASC is the ideal setting for younger, relatively co-morbidity-free patients.

Implementing the program
Ms. Bell and Ms. Armistead agreed that intense preparation is the key to successfully bringing total joints to the ASC setting. Here are three important steps.

•    Surgeon training. The surgeons at both surgery centers were well practiced in performing total joints in the hospital, but as soon as the decision was made to bring those procedures to the outpatient setting the surgeons began preparing. They ran trial runs in the hospital and determined patient selection criteria.
•    Staff and patient training. Total joint replacement is a higher acuity procedure, which demands staff members thoughtfully prepare. ASC staff and surgeons must also engage in preparing patients. "We are having patients go through boot camp," said Ms. Bell. Patients come in before the day of surgery to learn about the procedure and their postoperative care. The ASC admitting nurse, surgeon's PA and the patient's primary care physician are all involved in the boot camp.
•    Protocols. "We developed a book that addresses any complications that we cold possibly think of," said Ms. Armistead. All of the Campbell Clinic Surgery staff and surgeons became well-versed in that book and prepared for any situation.

23-hour stays and home health
As higher acuity procedures, physicians may be more comfortable with keeping patients for a longer period of time. Campbell Clinic Surgery Center has 23-hour stay capabilities. The center also has an agreement with a neighboring hotel for patient accommodations.

Though 23-hour stays are a helpful addition to a total joint program, it is not always possible. Located in Illinois, Hawthorn Surgery Center cannot offer 23-hour stays. But, the center still provides care for patients beyond their procedure time. The ASC is contracted with two different home health agencies, which will send qualified nurses to meet patients at their door as soon as they return from the ASC.

Payer contracting
Ms. Bell and Ms. Armistead both found that payer contracting was the biggest hurdle to cross during their preparations for total joints. "We have been working with our largest payer for nine months. They haven't seen this before," said Ms. Bell. "We have to provide them with education and data."

Campbell Clinic Surgery Center faced a similar struggle: being the first ASC in the area to introduce the idea of total joints. Ms. Armistead's center has actually been able to enter into "hybrid" bundled payment models with two of its largest payers. "The hybrid bundle includes preoperative care, surgery and postoperative care, everything but the surgeon's fee," she says.  

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