Becker's ASC Review

23 Moving toward success with outpatient total joint replacement surgeries By Frank Armocida, MD, Surgery Center at Pelham, Bill Hazen, Administrator/CEO, Surgery Center at Pelham and Nader Samii, CEO, National Medical Billing Services At the Surgery Center at Pelham, careful patient management leads to successful total joint replacement surgeries in the outpatient setting, while payer management leads to profitable financial outcomes. "Walking is the best medicine." – Aristotle S ince making the decision to satisfy patient demands in 2014,we have performed approximately 200 total joint replacement (TJR) surgeries at the Surgery Center at Pelham in Greer, South Carolina. Careful analysis aer each procedure has allowed us to optimize our outpatient care methods, as well as the complex coding, billing and patient education process we found necessary to provide quality care and maintain profitability. e benefits of moving TJR surgeries to the outpatient setting are numerous. Patients are normally discharged in three to four hours aer the surgery and recover in the comfort of their own homes without unnecessary services and surprise bills. e fact that the same exact procedure costs about one-fourth as much at our ambulatory surgery center (ASC) as it would in an inpatient setting allows patients to concentrate on their recovery rather than being burdened with financial worries. With the steady increase in healthcare costs, high deductible insurance plans and clinical advantages, it's not surprising that the patient demand for outpatient TJR surgeries is rising. Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) are projected to grow 73% from 1.1 million in 2016 to 1.9 million in 2026. While only 15%, or 165,000 total procedures were performed in an outpatient setting in 2016by 2026, this number will rise to 51%, or 969,000 total procedures. is represents an increase of approximately 487% over just ten years, according to Sg2 Research. 1 We are not only proud of the fact that we are able to offer TJR procedures, but we're also thrilled to set and meet patient expectations. Numerous factors attribute to the fact we have achieved 99% patient satisfaction rates. Perhaps most important, we've prioritized the education and concerns of cost-conscious patients as well as thoroughly addressed pre- and post-operation care. Learning to walk before you run and continually striving to improve is key when deciding to implement total joint procedures in an ASC setting. Aer each surgery, we carefully review the entire patient case, note what could have gone better, and rectify any factor found in order to streamline and perfect the process. We're aware that patients are attuned to high-cost healthcare and emphasize transparent pricing. Patients have the option to visit our website to receive an estimate of their cost of care based on a given surgeon's treatment plan and specific benefits provided by the insurance payor. We found early on that negotiating with vendors for the price of implants was not only possible, but also extremely beneficial, for the surgical payment process both as a healthcare provider and patient. We've used the same vendor for all implants, which allows us to negotiate a lower cost based on volume. We bill for implants at cost. Patient selection is a crucial process for ASCs to address when performing TJRs. With more data at our disposal, healthcare facilities can — and should — follow stricter guidelines while deciding which individuals are appropriate candidates for the procedure. Patients who are healthy enough can receive the exact same surgery and medications in an outpatient center that they would as inpatients, except possibly the anesthesia. Patients can recognize true outpatient benefits aer they receive the same quality post-op care, only at a more aggressive, accelerated rate with as little as three hours recovery time prior to discharge. Our staff then follows up with patients via a phone call - the day aer surgery and once a month for six months aer that. Two days aer the operation, surgeons will see patients in their office to change the dressings and reassure the patients in their early post-op recovery process. Strategies to help ensure quick release: • Optimizing patients. Patients considered candidates for a successful TJR surgery in an ambulatory surgery center are those who are middle-aged, have a body mass index (BMI) lower than 40 and are otherwise physically healthy. Uncontrolled diabetes, high blood pressure, chronic obstructive pulmonary disorder, high risk or history of deep vein thrombosis/pulmonary embolism, or a history of heart disease or stroke and other serious conditions are contraindications to outpatient TJR surgery. • Using general anesthesia. While a surgeon will more likely use a neuraxial block such as a spinal, for inpatient surgery, our surgeons use a general anesthetic combined with a periarticular block and a peripheral block for outpatient procedures, which allows patients to exit surgery prepared to walk and limits the likelihood of urinary retention issues. Sponsored by:

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