5 ASCs Performing Rare Orthopedic Procedures
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Cedar Orthopaedic Surgery Center (Cedar City, Utah). The single specialty surgical center has been performing outpatient total knee replacements since 2004, outpatient total hip replacements since 2005 and outpatient spine procedures, including microdiscectomies and decompressions, since 2008. According to Administrator Daron Pealock, RN, COSC, the facility works with cash pay patients as well as certain third-party payers.
"We have found that candidates who are generally healthy, well-informed and motivated do extremely well with outpatient total joint procedures. We've developed great relationships with home health services, rehabilitation facilities, physical therapy and lab services to assist in taking care of our patients postoperatively," he says.
Randy G. Delcore, MD, owner and medical director, is proud to have been part of this evolving trend involving the transition if healthy orthopedic patients from the 'sick environment' of a hospital inpatient stay to one of self-motivated 'healthy mobility' within their own home. Progressive anesthesia techniques including preoperative pain management, minimalization of narcotics intraoperatively, intraoperative pericapsular local anesthetic blocks placed by the surgeon and the use of non-narcotic medications postoperatively leads to happy patients without pain or nausea ready to discharge within a few hours, according to Mr. Delcore.
"It is amazing to see our patients up and moving shortly after their surgery and then to hear their success stories as we follow them through the recovery/healing process," he says. "Everyone in our center takes great pride in knowing that we are performing outstanding surgical procedures, with great outcomes and lower complications at a value that is, and always will be, unmatched by hospitals."
Florida Orthopaedic Institute Surgery Center (Tampa). The surgery center has been performing unicompartmental knee procedures since 2008 and total knee procedures since 2013, according to Debbie Baker, MBA, CASC, LHRM, chief administrative officer. The center accredited by the Accreditation Association for Ambulatory Health Care. It is a part of Florida Orthopaedic Institute, which includes a professional staff of more than 500 people and based in a 100,000-square-foot facility. It offers comprehensive orthopedic care.
Stone Clinic (San Francisco). The center has been performing BioKnee procedures since 1991, which replaces, regenerates or rebuilds damaged portions of knee cartilage and injured ligaments using advanced biologic techniques. According to Kevin Stone, MD, who heads the clinic, the procedure is a good fit for an ASC because it is an arthroscopic outpatient procedure that uses stem cells and/or donor tissues. The clinic aims at eliminating arthritis.
Dr. Stone also serves as the chairman of the Stone Research Foundation. He was trained in orthopedic surgery at Harvard University in Boston and has completed a fellowship in research at the Hospital for Special Surgery in New York. He holds over 40 U.S. patents and has served as a physician for the U.S. Ski Team, U.S. Pro Ski Tour and Honda Ski Tour.
Orthopedic Surgery Center of Orange County (Newport Beach, Calif.). The surgery center has offered total hip replacement procedures since 2007 and started a minimally invasive spine program in 2013, according to Gabrielle White, RN, CASC, executive director.
"[The total hip replacement program] started when one of our joint surgeons was looking for more operating room time," she said. "He believed that if his patients were walking the same of surgery and were being discharged the following day, with the right patient selection criteria to minimize risk, we could perform some of the cases at OSC. One out of four total joint surgeons uses our ASC routinely for total hip replacement and the others will look to us when they have a cash-paying patient who fits the criteria at the ASC."
Since starting the minimally invasive spine program, the center has performed simple minimal invasive laminectomy or discectomy and up to one to two level lumbar fusion and one to two level anterior cervical, discectomy and fusion. "Some centers are discharging ACDF same day, however, while we are still developing this program, we decided to keep these patients overnight for observation. Currently we have one surgeon out of three who are involved in our ASC that use our services for minimal invasive, ambulatory spine," said Ms. White.
Total hip and the spine procedures are a good fit for an ASC with the appropriate patient selection criteria — healthy and lower BMI, according to Ms. White. Total joint and one to two level spine fusions, along with non-instrumented spine procedures are more predictable in procedure, process and outcomes, which what helps the center better manage these cases and deliver the necessary care. However, while developing such programs, it is vital to have a couple of team members and the physicians to lead the change and continue to manage the expectations and quality.
"In 2007, it was a challenge to get some of the local payers to work with me for procedures that are predominantly inpatient," said Ms. White. "Over time and with enough data to demonstrate quality and lower costs, the payers have become more accepting and at OSC we have all major payers contracted for these procedures."
The surgery center is one of two outpatient centers within the Hoag Orthopedic Center of Excellence. It is accredited by the Accreditation Association of Ambulatory Health Care and provides surgical services for sports injuries, shoulder injuries, fractures, hand conditions and spine care.
University Center for Ambulatory Surgery (Somerset, N.J.). "We have been performing outpatient total joint replacements for close to 18 months now and have had phenomenal results. Our two principle joint surgeons, Dr. Steve Kayiaros and Dr. David Harwood have successfully performed anterior hip replacements, total knee replacements and unicompartmental knee replacements," said Dean Giacobbe, MD, medical director of UCAS.
Opened in August 2012, the 12,000-square-foot freestanding orthopedic specialty surgery center includes surgeons who perform the full spectrum of orthopedic surgical services, including sports medicine, upper extremity surgery, foot and ankle surgery, spine procedures, total joints and interventional pain management, according to Dr. Giacobbe.
"Our experience has shown that an increasing number of patients are great candidates for outpatient joint replacement because we have developed such a comprehensive program with full home support and state of the art pain management techniques," he said. "Our patients have confirmed our initial hunch, that is, that they would rather recover at home and have a much better experience than spending the usual three days in a hospital after their operation."
The center currently has three joint surgeons and there are plans to add additional joint replacements, such as shoulders or ankles.
"Our hope is that as this paradigm shift occurs, and more joint replacements are done in the outpatient setting, insurance carriers will begin to realize both the value added and cost savings for their clients and will be more willing to reimburse for these procedures rather than mandating they be done in an inpatient setting," said Dr. Giacobbe.
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