ASC total joint program bundles, vendors & more — 3 insights from an administrator

Joleen Harrison, BSN, RN, is administrative director at Mankato (Minn.) Surgery Center, a multispecialty, freestanding ASC with 32 surgeons and four operating rooms.

The ASC completes about 5,300 cases annually, including a handful of total joints.

Becker's ASC Review asked Ms. Harrison to discuss her center's total joint program

Question: What are the key elements of a successful outpatient total joint program?

Joleen Harrison: Our success is meeting with our patients before [the surgery] with all parties involved in their care — [the] nurse taking care of them at the center, the physical therapy group, the nurses from the rehab center (if they would go there for recovery) and the patient's friend or family that will care for them after surgery. We feel strongly about the involvement of the family because patients do need support for recovering. We also make sure we are following up with them the following day and several days after. We want to ensure the care they received exceeded their expectations. At the time of their preoperative appointment, we do stress the procedure is going to be painful and to expect pain. With the opiate crisis, we want to let patients know the pain level to help decrease the use of narcotics.

Q: How does your center handle reimbursement for total joint cases? Do you have any bundled payment contracts set up?

JH: We negotiate the reimbursement with our largest payers and bundle as much as we can. We are a rural to urban area and have patients that [travel] 50 to 75 miles to our facility, so physical therapy is the unbundle part of the procedure.

Q: What has been your experience negotiating high-cost implants?

JH: Our surgeons have involvement with vendors as well as Mankato Surgery Center. We try to ensure the pricing is the same as the other places our surgeons do total joints. We feel the volume of cases done in the surrounding areas by our surgeons should be considered as total volume when giving pricing. Usually, there is no negotiating with vendors when there is low volume. We do not know exactly what they have promised to our neighboring healthcare facilities. We are starting to use a vendor-comparison software program through our [group purchasing organization] that may help in the future to show us what other like-facilities pay for their implants. We hope this levels the negotiation process a bit for our future joint patients.

Interested in participating in future Becker's Q&As? Email Angie Stewart at

More articles on orthopedics:
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