Developing an ASC total joint program: Administrator Cami Love weighs in

Physicians at the Arkansas Specialty Surgery Center in Little Rock recently completed the center's first outpatient knee replacement. Administrator Cami Love described the process of developing the program for Becker's and shared how she expects the specialty to grow.

Note: Responses have been lightly edited for style and clarity.

Question: What was the process like for adding total joints to your ASC?

Cami Love: We started off first by seeing if we had a need for it, and if have doctors that wanted to do it, which we did. And the second thing we did was to go to our payers to negotiate with them to do a carve-out for total joints. We have a consultant who does that for us, and he was able to get three separate insurance companies to do a carve-out that allowed us to do total joints. What we did next was to determine what our costs would be.

I also went and visited another ASC that had total joints. I was able to network with them and get some samples of their workflow, which was huge. The facility that I went to was in Ohio, and they gave us a copy of their playbook. Then, we went over what the actual scheduling process would be, developed a patient checklist and determined how we were going to take care of the pre-assessments and the clearances. That was really helpful because the cost of doing total joints is extremely high. So it helps if you can get all of the providers that are going to be doing them on the same page.

We also met with billing and reimbursements to make sure we were billing everything correctly to maximize our reimbursement. We're a joint venture with the local hospital, so we got some information from their joint academy. When we did our patient education, we had a template to work from. We did extensive preoperative teaching with the patients, making sure they met with physical therapy and anesthesia.They also signed a contract agreeing they were going to keep their follow-up appointments. I felt like the patients had a really strong working knowledge of what to expect, and if they did have any sort of problem or complication, they knew what is serious enough to go to the ER for, or if they should just call case manager or the physician.

We did our first procedure recently, and it went great. The patient was discharged home within just a few hours. We followed up the next day, and he was doing great. By the third day he was at physical therapy. We learned from the first procedure, and I think we have an idea now about how to make things run smoother the second time around.

Q: What was the greatest challenge in developing the program? What advice would you give to other ASCs starting their own total joint programs?

CL: From start to finish, the biggest hurdle was payer contracts. Trying to get them worked out was a big challenge. We're in a state that is pretty much ruled by Blue Cross Blue Shield, and they tend to ride on Medicare's coattails.

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.

Q: How do you see your total joint program evolving or changing in the future?

CL: I think it's something that's going to continue to grow. Our first total joint procedure was a knee. We've already started on the process to do shoulders. And then the next thing we'll tackle will be hips. I really think starting a successful total joint program will help with getting carve-outs from other insurance providers as well. Then, that will pave the way for more ASCs to do it and have good results.

Q: Are you expecting any headwinds or challenges as the year comes to a close?

CL: We're in a very low reimbursement state. We were a little disappointed that Medicare's reimbursement was low for total joints. Something we're constantly working on in Arkansas is to get better reimbursement for orthopedic procedures that have a lot of implants and disposables which are bundled. We're trying to get more carve-out to help cover some of the big, expensive supply-heavy cases that are cost-prohibitive due to  reimbursement.

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