Three experts shared their insights outpatient orthopedics with Becker's ASC Review:
1. Trends in outpatient orthopedics, Louis Levitt, MD, vice president and secretary of the Centers for Advanced Orthopaedics in Bethesda, Md.:
"I believe that ASCs are going to follow the trend toward consolidation that much of the healthcare industry has already seen. I anticipate that a small number of corporate entities will begin a rapid acquisition of surgical centers, followed by consolidation and specialty concentration. In the future, surgical centers may operate similarly to acute care hospitals, with centers that specialize in joint replacement, or urology, or OB-GYN cases. Consolidation and specialization will allow for more efficient use of anesthesia, supplies and resources, more effective negotiations with payers and economies of scale that will benefit both the patient and the surgeon.
Patients will come to expect even higher quality, more efficient and cost-effective care in outpatient facilities that are comfortable, specialized and delivering strong outcomes. They’ll also have access — at their fingertips — to greater levels of transparency for pricing between hospitals and ASCs."
2. How to prepare patients for outpatient surgery, James Van Horne, MD:
"My team and I developed a program to optimize patients for joint replacement and achieve better outcomes. The program includes a joint coach, usually a family member or friend, who assists the patient peri-operatively. The joint coach helps them prepare preoperatively, manages their medications postoperatively and provides support for at least three days after surgery.
In addition, we help patients develop a strong social support net and create a personalized pain control program for when they undergo surgery. About 85 percent to 90 percent of my Medicare patients go home the same day. Nearly everyone goes home within 24 hours of surgery. Our complication rate is 25% below the national average, and we get patients off narcotics rapidly. We aren't sending patients to nursing homes, they aren't returning to the ER, nor being readmitted to the hospital due to complications."
3. The importance of payer contracts, Andrea Lessner, BSN, RN, total joint coordinator of Scottsdale, Ariz.-based North Valley Surgery Center:
"Payer contracts are essential for a successful outpatient total joint program, and the work needed to negotiate these contracts should not be underestimated. A surgeon interested in moving cases to an outpatient setting will test sending their inpatients home at 23 hours, 18 hours, six hours, while collecting complication and readmission data. This data will be essential when negotiating a contract that meets an acceptable margin. I have seen surgery centers invest in huge capital items prior to having any contracts in place or do cases with a contract that gives the milk and the cow away for free! Start with one contract and take care of those patients how you would like to be taken care of and build your database."