How to build a successful total joints program: 3 experts weigh in

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While ASC total joints programs are popping up across the country, the difficulty of developing these programs still persists.

 In a panel at the Becker's ASC 23rd Annual Meeting in Chicago, two ASC executives and a surgery center administrator shared their insights on developing and maintaining a successful total joints program.

Panelists included:

  • Adam Berry, CEO of Summit Orthopedics in Minneapolis/Saint Paul
  • Deborah Crook, administrator for Rush Surgicenter in Chicago
  • Craig McAllister, MD, president and CMO of Kirkland, Wash.-based SwiftPath

Here are the top soundbites from their discussion, lightly edited for clarity.

Best piece of clinical advice:

Dr. McAllister said, "Don't underestimate just how different ASC joint replacement is." If ASCs attempt to conduct outpatient total joints procedures using the same surgical techniques as in a hospital setting, fail to develop a robust home monitoring program and don't update pain management strategies, they'll see high readmission and complication rates, according to Dr. McAllister. "Nobody doing joint replacements wants to be in the headlines for the wrong reasons," he said.

Mr. Berry said, "Make sure you have consistency and uniformity as a provider group … you need to collectively define and develop a common pathway where everything from the cocktail anesthetic down to the sutures is the same … The more you can adhere to that consistent pathway, the easier you can move into a different level of performance."

Ms. Crook said one of the most important things an ASC can do for patients is provide thorough education and preparation prior to the procedure. "Bring them in, tell them what to expect and prep them that they're going to be going home. You need to identify the needs they're going to have when they do leave, as well," said Ms. Crook.

Best piece of business advice:

Dr. McAllister said good communication with payers is key. "We asked the major players — Aetna, Providence, BlueCross, UnitedHealthcare — what their formula was to get these contracts for ASC-based joint replacements … the payers said ASCs need to have a consistent pathway, demonstrate positive readmission and patient satisfaction rates and show a very strong patient education component," Dr. McAllister said.

Mr. Berry said when launching a total joints program, you must be assertive and aggressive with your health plan during negotiations with payers. "Some health plans will find every possible obstacle to get in your way. If you are aggressive and show the payers what the benefit is for their members, then you'll benefit on the business side as well," he said.

Ms. Crook said, "Identifying your can-do staff really helps to quickly get a joint program off the ground. Find these highly motivated individuals and use them as the core group to get the program running. The group can quickly identify things that aren’t working and then you can bring other staff members in after."

Biggest mistakes:

Dr. McAllister said the single biggest mistake he sees when working with individuals attempting to implement an ASC joint program is the mindset that they can get the program running successfully on their own. "It’s not simple to switch to home pain management. Don't try to go it on your own. Take advice from the people who have been there before," he said.

Mr. Berry said, "For our financial modeling, we assumed what was happening today would happen in the future. We modeled the number of rooms needed for our care suite environment based off the average length of stay currently happening at the hospitals, which was about two nights at the time. We found that estimate was drastically wrong. Now, five to ten years later, about less than 1 percent of our patients stay two nights … so don't look at what today's world is, find out where it's going to."

Ms. Crook said many ASCs don't take advantage of vendors' excitement about the site of service transition from hospitals to surgery centers. "You can leverage vendor excitement. If you get creative through disposable use agreements, etc., you can bring what you need to a total joints program without laying out all that capital."

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