Jared Roberts, MD, is an orthopedic surgeon at Albany, N.Y.- based The Bone & Joint Center. Recently, he performed one of the area's first outpatient hip surgeries at the Capital Region Ambulatory Surgery Center in Albany.
Becker's ASC Review spoke with Dr. Roberts about starting outpatient joint programs, the trends to know and advice he'd give to other surgeons:
Question: What advice would you give to other surgeons looking to perform total joints in the ASC setting?
Dr. Jared Roberts: First, you have to start in an inpatient setting and try to work out all the kinks before you jump to the outpatient setting. So, you have to get your protocols into place for pain medications, physical therapy and expectations.
The most important thing is education for the patient, making sure they understand what the plan is so their expectations as well as your expectations are the same. One of the other questions [to ask] is about patient selection. I think that's probably the No. 1 factor. You've got to pick the patients who are appropriate for the surgery center both from a medical standpoint, but also from a standpoint that patients understand they're going to be leaving that same day.
Q: Who is the ideal patient for an outpatient procedure?
JR: No. 1, young patients on commercial insurance who understand expectations [with] an appropriate BMI under 30. No. 2, a patient who is narcotic-naive that is physically fit for the surgery.
From a medical standpoint, you don't want a patient who is on blood-thinners, has uncontrolled diabetes or significant cardiac issues.
Q: What insights do you have for ASCs looking to start their own total joint programs?
JR: Seek out other ASCs that are doing total joints. There's no reason to reinvent the wheel. There [are] places out there that are more than willing to educate other ASCs to show them the protocol that needs to be put in place and the appropriate patients.
You have to have a buy-in from everybody in the ASC, from the pre- and postoperative nurses and the OR nurses, so that everything is place.
Test it in the [hospital outpatient department] setting so you can see if patients can go home [the] same day from the hospital before transferring [cases] to the ASC.
Q: As a surgeon, what trends are you seeing in outpatient total joint replacement?
JR: We will continue to see the expansion of the number of outpatient total joint procedures to almost every community in the country at some point in the future. It's like [anterior cruciate ligaments] that were done in the past in the hospital, and now almost zero ACLs are in the inpatient setting unless there's some circumstance that has forced it into the hospital.
I think we're going to see more communes adopt [outpatient total joints], and it's going to become the norm. I think in a short period of time we're going to see Medicare allow us to do outpatient hip and knee replacements.
The ASC setting is safer for the patient from an infection standpoint, it's cheaper to the overall healthcare system and the fees that are charged for an outpatient joint replacement are half of what they are in the hospital. These things are going to become more and more apparent as the Baby Boomer population needs more and more joint replacement. This is going to be one of the ways Medicare can save money, as well as commercial payers. I really believe outpatient total joints in ASCs are the wave of the future.