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58 HEALTHCARE NEWS The evolution of total joint replacements from the hospital to the surgery center Key Steps for ASCs to Maximize Quality and Profitability of Total Joint Replacements By Nader Samii, CEO, National Medical Billing Services T otal joint replacement surgeries are projected to grow rapidly in the coming years, and there will be a significant mi- gration of these cases from the inpatient to the outpatient setting. Consider the following: • e number of hip and knee joint replacement surgeries performed in an outpatient setting is expected to grow 73% from approximately 1.1 million today to approximately 1.9 million by 2026. 1 • Approximately 51%, or 969,000, of primary hip and knee joint replace- ment surgeries will be performed in an outpatient setting by 2026 — up from just 15% in 2016, or 165,000, according to Sg2 Research. 1 is is an increase of 487%. • e number of ASCs offering outpa- tient joint replacements increased from 25 in 2014 to more than 200 in 2017. 2 • e movement of surgical proce- dures from an inpatient setting to an outpatient setting saves commercial payers $38 billion and CMS $2.5 billion annually, according to an Ambulatory Surgery Center Association (ASCA) study. 3 • Private equity investments in ortho- pedic practices are expected to grow significantly in the next five years, according to a report from healthcare investment bank Edgemont Capital. 4 is growth is highly correlated with the dramatic growth in complex ortho- pedic procedures and the significant movement of these procedures from inpatient to ASCs. As an ASC leader, however, it is critical to understand that "opportunity does not waste time with those who are unprepared." ese are words of advice from Idowu Koyenikan, the author of "Wea-lth for All: Living a Life of Suc- cess at the Edge of Your Ability." 5 Preparation is especially important when considering what is at stake with joint replacement surgeries. In- deed, with a joint replacement procedure, your facility will spend thousands of dollars on the implant, use considerable staff hours to perform the surgery and take up valuable operating room time. As such, you need to make sure you are collecting enough money to cover your expenses, realize a solid profit and position your center for additional growth. More specifically, to successfully handle total joint surgeries, your ASC needs to: 1: Get payers onboard. Convincing payers that total joint procedures belong in the ASC environment is job number one. Providing real- world examples of cost savings can be convinc- ing. While reimbursement varies on a hospital by hospital basis, and on an ASC by ASC basis, it is common to see 30% to 50% cost savings for payers when a total joint procedure is done at an ASC rather than at the hospital—a savings of billions of dollars annually for payers. 2: Go straight to employers. Entering into direct- to-employer contracts with specific companies could help bring more total joint procedures to your facility. Consider approaching larger employers and offering them a discount for employees in need of total joint surgery in exchange for encouraging employees to choose your ASC. 3: Understand your data. Understanding inpa- tient costs in the local market, as well as how much it costs to build and operate a total joint program, can help you get a handle on exact total costs. With this information, you can then negotiate contracts that produce a margin with a significant impact on your bottom line. 4: Develop world-class clinical protocols. It is important to leverage the experience of the most seasoned orthopedic surgeons and their top staff members to recreate or even improve upon the clinical processes and protocols that were developed in the inpatient and/or hospital outpatient departments. is relates to staffing, communications and best practice protocols, and should include surgeons, anesthesiologists and front-office team members, as well as pre- op, intra-op and post-op nurses. 5: Recruit the right patients. Outpatient joint replacement surgery is a viable, and oen preferable, option for middle aged, non-obese patients who do not suffer other significant medical conditions and who have strong at- home support systems in place. Patients with the following contraindications should not be considered for outpatient joint replacement surgery: BMI greater than 35, age over 60, chronic obstructive pulmonary disorder, dia- betes, cardiovascular disease, smoker, high risk of history of deep vein thrombosis/pulmonary embolism, anticoagulant therapy, anemia and difficult surgery due to deformity. 6: Get front desk staff up to speed. Front desk staff members need to know how to secure proper total joint replacement pre-authoriza- tions from payers for each total joint procedure. As such, they need to ensure that patients meet all pre-surgery requirements. In addition, they should obtain a preauthorization for a variety of codes, as the surgeon may need to change or modify the procedure aer surgery begins. 7: Understand the payer and its requirements. Your front desk staff needs to make sure they identify the correct payer contract for each procedure. While the current procedural terminology (CPT) code will be the same under each contract, it is likely that the implant will be treated differently from contract to contract. For example, one contract might include pay- ment for the implant in the overall rate for the procedure, while another might pay for the pro- cedure, plus pay a certain amount for the im- plant, including shipping, handling, and taxes. It is important to note each contract is different References 1 Vizient. Outpatient Joint Replacement: An Unnecessary Concern or Market Reality? https://newsroom.vizientinc.com/newsletter/research-and-insights-news/outpatient-joint-replacement- unnecessary-concern-or-market-rea 2 Advisory Board. Hospitals may lose total joint replacements to ambulatory providers. Here's what they're doing about it. https://www.advisory.com/daily-briefing/2017/08/10/joint-replacement 3 Ambulatory Surgery Center Association. Study: Commercial Insurance Cost Savings in Ambulatory Surgery Centers. https://www.ascassociation.org/advancingsurgicalcare/reducinghealth- carecosts/costsavings/healthcarebluebookstudy 4 Edgemont. Edgemont 2018 Orthopedics Outlook Report. https://www.edgemont.com/insights/edgemont-2018-orthopedics-outlook-report/ 5 Good Reads. Wealth for All Quotes. https://www.goodreads.com/work/quotes/48666706-wealth-for-all-living-a-life-of-success-at-the-edge-of-your-ability