Becker's ASC Review

28 Executive Briefing pumps has gotten better, and patients are waking up without much pain, allowing us to gain control of the situation." Dr. Knapke also significantly limits the amount of narcotics prescribed to patients after surgery, using multimodal analgesic techniques. He educates his patients about the potential side effects of narcotics and informs them that they will receive a limited number of pills to use judiciously. Top-notch surgical system Beyond pain management, another key aspect to achieving great outcomes is selecting the right surgical device and system. For knee replacement patients, it's important to use an implant that will align with the patient's anatomy and allow them natural range of motion without additional pain or instability. "The Microport's Evolution MP Knee System is one of the most stable on the market because of the medial pivot design," Dr. Knapke said. "It's a high-end knee, a top-notch knee to put into someone with high activity levels, like the otherwise healthy patients who undergo surgery at the ASC." There is growing interest in the Evolution MP Knee System in the national marketplace, said Dr. Sah, because it offers distinct kinematics when compared to other products. He reports his patients have less pain after knee replacements and request fewer narcotics, which he attributes to the implant design. "That really makes the Evolution knee an ideal fit for the ASC and we see great results clinically," Dr. Sah said. "Any one failure can undermine the success of the other aspects of outpatient surgery, and the Evolution knee has the characteristics necessary to optimize outcomes and to help your patients achieve a fast recovery." Some studies suggest up to 20 percent of knee replacement patients do not report a good to great outcome, according to a 2018 study published in HHS Journal. i In many cases, instability is the cause of dissatisfaction. However, Dr. Knapke doesn't worry about instability with the Evolution MP Knee System. "I feel like I'm giving patients the best knee replacement I can give them. They trust the knee quickly because it feels solid to them," he said. Great patient communication A third core concept for successful total joint programs in the ASC is established lines of communication during the postsurgical period. Dr. Knapke gives each patient his direct phone number, as well as the direct line to anesthesiologists, so patients have immediate access to him post-discharge. ASCs can also develop protocol for the initial communication with patients after they return home, increasing the touchpoints with clinicians during the postoperative period. "We make sure to answer any discharge questions they have and keep in regular communication for two to three days after they return home," Dr. Knapke said. "We also work with specific home health companies that know our expectations for protocols and communication. The home health specialists can text me any time with a concern about one of my patients, so we are all on the same wavelength around patient care." Discharge home and catching potential issues early to prevent readmissions is an important aspect of quality care, especially for those participating in bundled payments. To be successful in the bundles, Dr. Knapke said surgery should be performed in the ASC as much as possible and control post-acute care costs. "It all comes down to having the program in place and everyone being aware of the protocols," he said. Educating patients on the benefits of returning home after discharge can also reduce costs and complications related to being discharged to skilled nursing or rehab facilities. Home health agencies and outpatient physical therapy allow patients to return home with the same level of care. "Because the time between surgery and discharge is so compressed with outpatient surgery, there are fewer interactions with the patient before they are on their way home, and they might feel abandoned if there isn't enough communication," Dr. Sah said. "It's important that we bridge that communication gap with availability of our staff, who reach out by phone and encourage patients to text or email them with questions. Outpatient surgery is not about reducing their services, it's about engaging them in a more cost-effective way." In conclusion As the healthcare system moves more toward value-based care and bundled payments, the ASC will play an increasingly important role in surgeons providing high quality, low-cost knee replacement surgery. The pain management techniques and minimally invasive surgical systems, coupled with pre- and postoperative protocols to optimize patients, allow surgeons to perform more cases successfully in the ASC. However, they need the right partnerships, surgical systems, and mindset to achieve the best results. Individual results and activity levels after surgery vary and depend on many factors including age, weight and prior activity level. There are risks and recovery times associated with surgery and there are certain individuals who should not undergo surgery. These surgeons are paid consultants for MicroPort Orthopedics. The opinions expressed are theirs alone and do not necessarily reflect the opinions of MicroPort Orthopedics Inc. i Kahlenberg, C.A., Nwachukwu, B.U., McLawhorn, A.S. et al. HSS Jrnl (2018) 14: 192. https://doi.org/10.1007/s11420-018-9614-8 MicroPort Orthopedics delivers the latest in orthopedic technologies and procedures for the repair and reconstruction of the hip and knee joint. At MicroPort Orthopedics, our aim is to help patients return to full function, faster.

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