Successful total joint replacement bundles in ASCs: 2 factors to prioritize

Bundled payment programs are picking up steam as the healthcare industry shifts to value-based care, and according to Surgical Directions, ASCs can successfully participate in total joint bundled payment programs if they keep a few key things in mind.


Jeff Peters, the president of Surgical Directions, and Thomas Blasco, MD, an anesthesiologist, medical director with Surgical Directions and medical director at the Illinois Sports Medicine and Orthopedic Surgery Center in Morton Grove, discussed ASCs and bundled payments during the Becker's ASC Review 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine on June 23.

"Bundled payments are important," Mr. Peters said, noting the model benefits patients and, if done well, can be a financial boon for orthopedic surgeons.

He said the key to making a bundle make sense financially in an ASC setting is having the patient go home to recover, as opposed to going to a higher-cost site of care like a skilled nursing facility, rehab facility or hotel.

And for that to happen — for patients to go home from a total joint surgery within 24 hours — surgery center operators and physicians need to keep two main things in mind.

Patient selection. Not every patient should undergo a total joint surgery in an outpatient setting. "Triage of patients is key to maximizing success and limiting problems," Dr. Blasco said.

After word gets out that total joints are available in an outpatient setting, many patients will ask if they can have it done in the ASC, Dr. Blasco said. But setting boundaries when it comes to BMI or age is paramount.

Consistency. Once the patient is chosen, it's important to keep the process as consistent as possible from surgery to surgery. At Dr. Blasco's center, just four surgeons perform lower extremity total joint replacements. "We got them to agree processes will be the same for every single patient," he said.

That includes patient screening and education prior to surgery to the type of anesthesia to the physical therapy, discharge and follow-up process.


At Dr. Blasco's center, more than 150 patients underwent a lower extremity joint replacement, and all of those patients have been discharged home with no skilled nursing facility transfers.

"ASCs [are] the best organization to be the leader in how a bundle is produced," Dr. Blasco said, and keeping those two factors in mind will help surgery centers find success under the bundled payment model.

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