5 expert insights on outpatient joint replacements in 2019

Here are five key insights on outpatient total joint programs from experts interviewed by Becker's ASC Review:

1. Cami Love, administrator at the Arkansas Specialty Surgery Center in Little Rock:

"For ASCs wanting to start their own programs, I would start with letting your medical director take the lead. I also think having anesthesia involved from the very beginning is very important as well. Inclusion and exclusion criteria is also key. You have to have healthy patients, or they're not going to have a good result."

2. Carolina Bone & Joint Surgery Center administrator Georgia A. Kapshuck:

"In our case, a successful total joint program begins with surgeon leadership. Having an experienced surgeon craft a clear protocol outlining the general formula for perioperative management sets the stage for success. Couple this with a cadre of total joint surgeons who buy into that protocol, and the program is nearly guaranteed to start out on the right foot.

However, to ensure that the program maintains quality and grows from its successful inception, an able, detail-oriented total joint coordinator is an absolute necessity. This person must be a skilled communicator, able to interface with patients, surgeons, OR staff and clinical staff both in the surgery center and in surgical offices. A good coordinator also can keep track of the numerous prerequisites that patients must have in place prior to surgery: medical optimization, lab studies, home health arrangements, education, perioperative medications, physical therapy arrangements. The list can be daunting."

3. 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."

4. Brian Schwartz, MD, orthopedic surgeon at Illinois Bone & Joint Institute:

"I think the most important thing is patient selection. You need to have a healthy patient, a motivated patient, someone that has a good support system at home that can help carry them through the first couple of days of recovery.

Then you need to have a good team around you. It starts with anesthesia and the surgeon, but it's also important to have a physical therapy team and a post-op nurse that's experienced in getting people up and moving right away. Also, a trusted, experienced home health RN and physical therapy team is an essential element to the process. We're trying to break down the culture that if you have your hip or knee replaced you need to be in the hospital for two or three days because that is definitely no longer the case.

If someone is starting this de-novo, I would recommend to travel to a center that's been doing this for a long time and see in person the process from beginning to end. That way they're not reinventing the wheel from scratch because it's being done successfully across the country."

5. Louis Levitt, MD, is vice president and secretary of the Centers for Advanced Orthopaedics:

"I believe that orthopedics is leading the trend toward outpatient procedures. Orthopedic surgeons routinely perform complex surgeries in an outpatient setting, including joint replacements, ACL reconstructions and spinal fusions, to name a few. As a specialty, orthopedics is a leader in demonstrating how to take full advantage of the outpatient setting to maximize efficiency and improve the patient experience and outcomes."

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