Becker's ASC Review

Dr. Ravi Bashyal: Key trends in outpatient knee, hip surgery By Laura Dyrda R avi Bashyal, MD, is an orthopedic surgeon and director of outpa- tient hip and knee replacement surgery at NorthShore University HealthSystem in Skokie, Ill. Here, he discusses the big concepts and ideas around outpatient joint replacements. Q: What are the biggest technology trends you are seeing in outpatient knee and hip surgery? Dr. Ravi Bashyal: e use of innovative technology to help enable successful outpatient total joint replacement continues to expand. One game changing technology in this space is patient-specific instrumenta- tion for total and partial knee replacement. is technology emphasizes customization and pre-operative planning to allow for more accurate and efficient surgery. It can also reduce the number of trays and implant inventory needed for surgery which has a direct impact on lowering cost. Another trending technology is the use of portable negative pressure wound therapy dressings. ese unique dressings can help to manage post-surgical drainage and edema, and may improve perfusion and incision healing, all while providing an occlusive barrier to the outside environment. is type of management has been shown to decrease wound complications, decrease readmission, and improve early out- comes, all of which are critically important in the outpatient space. Q: Half of your outpatient procedures return home without any narcotics. To what do you attribute your success? RB: e biggest part of our success with sending patients home, and with minimal or no use of narcotics, is effective communication and standardization. e patient, their family, and our team's mentality is that they will have minimal pain from start to finish. We begin the messaging on their first office visit and this is continuously reinforced throughout the outpatient process and even aer they are at home. Q: What challenges are there for taking total joint replace- ments outpatient? How are you overcoming them? RB: e biggest challenge is managing touch points, which means managing all the interactions with the patients and their families. e messaging to the patient has to be consistent, from the initial office visit with me and my team, to the anesthesia encounter immediately before surgery, to the post-op discharge instructions from the recovery room RNs – and all the interactions with staff in between these. It can be a challenge to have all the stakeholders in this process on the same page. It takes effort and persistence to accomplish this – but once done, allows for a seamless concierge level experience for patients and their families. Q: What are you doing today to prepare for the future? RB: We are trying to embrace innovative technology where appro- priate. We accept that hip and knee replacement surgery has been a historically successful procedure in the inpatient setting. at being said, improvements including the technologies and messaging strate- gies discussed above are allowing us to safely transition many cases to the outpatient setting. We continue to evaluate and adopt innovative technologies to help accomplish these goals. Ultimately, we must sustain and maintain the safety and high-quality out- comes of these procedures while maximizing efficiency and productivity. We are also preparing for a larger population of outpatient total joints and learning how to better identify those that are appropriate for the outpatient setting will be key as this space continues to expand and grow. n USPI has around 6% of ASCs, Tenet to keep investing in growth By Laura Dyrda A t the Morgan Stanley Global Healthcare Conference on Sept. 9 in New York City, Tenet CEO Ron Ritten- meyer discussed the company's performance and what to expect from both its hospital and ASC segments in the future. Tenet reported growth for the hospital segment and United Surgical Partners International, its ASC arm. "We actually feel very good about where we are," he said. "When I step back and look at the transformation that we've been executing within the company, I believe it's not only on track, but it's do- ing a little bit better than what we expected." The company just finished refinancing its debt and is now fo- cused on cash and cash accumulation to then pay down the debt. He also said the company will continue to monitor the portfolio to determine any assets that need to be "disposed" of; however, he does not expect to name those assets ahead of time. He also said reestablishing volume growth in both the hos- pital and ASC segments was a top priority for the company, especially as higher acuity cases migrate to the outpatient setting. Saum Sutaria, MD, COO of Tenet, said, "The ambu- latory environment is growing and it's growing rapidly. We are very happy with the fact that both the USPI and hospital assets participate significantly in outpatient [surgery]." He said he sees a big opportunity for USPI centers to part- ner with health systems across the country and drive outpa- tient growth. The company is also focused on bringing new physicians on board. "From our standpoint, we will continue to invest in USPI," said Mr. Rittenmeyer. "[The ASC market] is a very fragment- ed area, and we own about 6 percent of facilities out there. So, when you think about it, we have a tremendous oppor- tunity still for consolidation as well as de novos." Finally, Mr. Rittenmeyer also reinforced the company's plan to spinout Conifer, and said it was on schedule. n 150 SPINE AND ORTHOPEDIC SURGEONS AND PAIN MANAGEMENT PHYSICIAN SPEAKERS, OVER 250 SPEAKERS TOTAL Thought Leadership 26

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