What to know when launching an outpatient total joint program: Dr. Michael Chmell shares his insight

Michael Chmell, MD, is the medical director of Rockford-based OrthoIllinois Surgery Center. Here, he shares the top orthopedic trends and tips on how to get a total joint program off the ground.

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

Question: What changes or opportunities are you expecting to see for outpatient total joints in the coming years?

Dr. Michael Chmell: I would expect to see continued dramatic growth in outpatient total joints, both in terms of absolute numbers and in terms of the number of facilities offering outpatient total joints. This growth will be due to numerous factors: patient and payer demand; the recent approval of Medicare outpatient total knees, with hips likely to follow; and the increase of commercial bundle payments making outpatient ASCs an even more desirable location. The biggest driving factor behind the growth, however, is the continued documentation of the safety and efficacy of outpatient total joints.

Q: Are there any kind of overarching trends that you're seeing right now in outpatient orthopedics?

MC: Outpatient orthopedic surgery is dramatically different today than even five to 10 years ago. Essentially all orthopedic cases, aside from acute trauma and complex spine, can be done in an outpatient setting. Our orthopedic ASC is basically no different from a hospital, except no one stays overnight. The same cases are performed, requiring the same labor. This is a very important consideration, impacting all facets of an ASC, from scheduling to storage space to staffing needs.

Q; How do you hope the ASC industry will change in the coming years?

MC: The ASC industry has gained and will continue to gain greater respect within the general medical community, the public and the media. The benefits of ASCs regarding outcomes, patient satisfaction and cost are being recognized more today than a decade ago, and I believe this will continue.

Q: Is there any new technology you're looking forward to on the horizon?

MC: The new technologies impacting ASCs will need to center around reducing costs either directly through alternative implant manufacturers or pricing structures, or indirectly by minimizing storage space or sterilization requirements by reducing surgical trays.

A second technology needed in the orthopedic ASC world is improved methods of reporting and consolidating the quality data of all ASCs, particularly regarding specific procedures such as outpatient total joints. This would provide much-improved resources for each individual ASC regarding documentation of safety, efficacy, cost and patient satisfaction on a large scale.

Q: Do you have any tips or things to know before starting a total joint program?

MC: Five years into developing and overseeing an outpatient total joint program, the 'tips' we have learned are endless. First, a surgeon champion is needed to set up and organize the protocols pre-, post- and intra-op. The key components of performing successful outpatient total joints occur preoperatively. First is proper patient selection; next, vigorous patient education; and finally, patient preparation.

Trial runs should be undertaken at a hospital to assure the plan works and to establish confidence among the team. The ASC needs to be ready well before the first case. Perform a dry run with the staff to familiarize them as to the surgeon's preferences, including patient positioning, prepping and draping, instruments, etc. The majority of an ASC's staff may be years removed from any total joint exposure. Needed storage space and sterile processing capacity for total joints is dramatically different from most other orthopedic cases and needs to be evaluated.

The biggest take-home message is that to do a significant volume of outpatient joints is not a small endeavor by any means and requires significant dedication, planning, patience and often financial outlay due to space constraints.

Q: Do you think private equity will have an impact on the orthopedic specialty? Why or why not?

MC: I am unable to speak to the impact of private equity, as this is out of my area of expertise. I would, however, vehemently recommend that orthopedic surgeon ASC owners maintain ownership to as great an extent as they are able. ASCs are more important now than ever to independent surgeons. This is not only from a financial standpoint, but equally from a control standpoint in terms of relationships with large health systems and insurers.

More articles on orthopedics:
14 things to know about total joint replacements and ASCs for 2020
Andrews Sports Medicine's Dr. Marcus Rothermich on the future of outpatient orthopedics
Private equity's potential impact on orthopedics: 5 surgeons' views

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