How North Valley Surgery Center is elevating its total joint program — 4 Qs with a program coordinator

Payer contracts, surgeon leadership, clinical pathways and a commitment to superior care are the key elements of a successful outpatient total joint program, according to Andrea Lessner, BSN, RN, total joint coordinator of Scottsdale, Ariz.-based North Valley Surgery Center, an HonorHealth affiliate managed by Sovereign Healthcare.

Ms. Lessner shared her insights with Becker's ASC Review.

Note: Responses were lightly edited for style and length.

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

Andrea Lessner: We have commercial contracts for our total joint procedures, and we utilize 27446 for our Medicare unicompartmental arthroplasty cases. We do have one bundled payment contract, and due to our safe patient selection, preoperative optimization, risk stratification and 90-day postoperative case management processes, it has been advantageous for all parties. We are seeking other bundled payment contracts with our excellent patient outcomes data and our upcoming AAAHC Advanced Orthopaedic Certification survey.

Q: How do you plan to grow North Valley Surgery Center's total joint program?

AL: Since 2017, we have increased our total joint volume by 277 percent and continue to grow volume by adding providers who follow our clinical pathways. We have invested in infrastructure and technology to drive consistent year-over-year growth. We have the technology, equipment and clinical teams that are essential for minimally invasive outpatient joint reconstruction procedures. We specialize in robotic knee replacement and anterior approach hip replacement. Robotic programs are not just for hospitals; we have five surgeons who are certified and performing cases at our facility and three surgeons who are currently in training.

Q: What differentiates your center's total joint program from others?

AL: We truly do outpatient total joints. Our patients are discharged home within two to four hours of surgery, not 23 hours. We do all of our own preoperative assessments, patient education, total joint classes and follow-up calls at day one, week one, and 30, 60 and 90 days postoperatively. I give every patient my cellphone number. Some people say I am crazy for doing this, some say it's concierge care. I do it because that's how I would want to be taken care of. Team members come and find me in the morning and ask how Beth is doing from yesterday, and I get to tell them that she has less pain the day after surgery than the day before surgery, she is only taking Tylenol for slight muscle soreness and she thanks everyone for their amazing care. This feedback loop drives our team to provide excellent care because their work is constantly being rewarded by happy patients.

Q: What's the most difficult part of your role as an outpatient total joint coordinator?

AL: I think the most difficult part of my role is preparing for the release of 27447 to ASCs. On July 29, CMS released its proposed rule for 2020, which would make total knee arthroplasty (27447) payable in ASCs. While we are waiting on CMS' final rule, I am confident that clinically qualified Medicare patients should be able to have access to efficient cost-effective care. We have tested our preoperative assessments, risk stratification and clinical pathway protocols with all our Medicare [unicompartmental] patients and we have proven we can safely deliver care with outstanding outcomes.

Q: What's the most rewarding part?

AL: The most rewarding part of my job is our patient satisfaction, and it is only accomplished through a tremendous amount of teamwork. Our surgeons, anesthesiologists, nurses, scrub techs, [certified sterile processing department] techs, physical therapists, registration department, administration and strategic business partners support the delivery of world-class care.

Would you like to participate in future Q&As? Email Angie Stewart:

More articles on orthopedics:
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Dr. Thomas Parisi, patient travel to Mexico for total knee replacement where it costs $18,000 less

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