Getting ahead of outpatient trends: 5 best practices for migrating spine, total joints to your ASC

An increasing number of ASCs are adding higher acuity cases such as total joint replacements and spinal procedures, but it takes significant time and resources to develop a successful program.

During an Oct. 15 session at Becker's ASC Virtual Event,  sponsored by Mizuho OSI, one ASC CEO and two surgeons discussed key considerations and best practices for implementing total joint and spine surgeries into the ASC setting.

Participants included: 

  • Cory Hall, CEO of Marin Specialty Surgery Center in San Rafael, Calif.
  • Brian Su, MD, spine surgeon at Marin Specialty Surgery Center
  • Daniel Chan, MD, orthopedic surgeon at Cypress Creek Outpatient Surgical Center in Fort Lauderdale, Fla.

Five key takeaways:

1. Collaboration breeds success. Launching a successful program requires a collaborative effort from providers and administrators. Adding new service lines will naturally lead to increased demands on your staff. It's important to ensure that your director of nursing, post-anesthesia care unit manager and operating room manager are engaged "not only with the procedures and protocols, but also with policy creation," Mr. Hall said.

2. Manage costs. Adding spine and total joint service lines can come with a significant capital expense, so having a well-organized investment strategy is critical. The most successful programs provide great outcomes from the get-go. Consult with your surgeons about preferred equipment and tools, including surgical tables, high-speed drills, implants and specialty cauterization devices. Set your surgeons up for success, and don't cut corners on specialized equipment. 

3. Evaluate contracts. Different regions of the country have a different blend of payers. Is your ASC in a heavy Medicare or private pay region? Do your physicians perform a lot of workers' compensation cases? Know what your payers reimburse and if they reimburse for implants, Mr. Hall said. Establish whether your current contracts are viable to start a spine or total joint program, or if you will need to renegotiate these contracts.

4. Gradually phase in cases. When migrating cases to the ASC, anterior cervical fusion and cervical disc replacement cause particular angst for spine surgeons, according to Dr. Su. Surgeons want to perform "high quality care, as good, if not better than" their local hospital, and do it in a very safe setting. Master and migrate more straightforward cases first — such as micro decompression and lumbar microdiscectomy — before phasing in more complex spine surgeries.

5. Highlight your practice through online marketing. Orthopaedic surgery is the highest patient-consumerism driven specialty especially for elective procedures such as hip and knee replacement, according to Dr. Chan. Patients are increasingly doing online research as a primary method for choosing their surgeon, so devoting resources to highlighting your practice including the use of innovative techniques and equipment will be an important part of a practice marketing strategy. Soliciting positive feedback from patients that is posted on sites like Google, Facebook, Healthgrades, WebMD, and others has factored into prospective patients' decisions to choose a surgeon over another. In addition, Dr. Chan states that patients will often call his office requesting both an anterior approach hip replacement as well as the use of the "special orthopaedic table", or Hana table based on their own research into what can facilitate a good outcome after hip replacement surgery.

Click here to learn more about Mizuho and here to view the full session on-demand.

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