Becker's ASC Review

31 ORTHOPEDICS 5 expert insights on outpatient joint replacements in 2019 By Rachel Popa H ere are five key insights on outpatient total joint programs from experts interviewed by Becker's ASC Review: 1. Cami Love. Administrator at the Arkan- sas Specialty Surgery Center (Little Rock): "For ASCs wanting to start their own pro- grams, I would start with letting your medi- cal director take the lead. I also think having anesthesia involved from the very beginning is very important as well. Inclusion and ex- clusion criteria is also key. You have to have healthy patients, or they're not going to have a good result." 2. Georgia A. Kapshuck. Administrator of Carolina Bone & Joint Surgery Center (Myrtle Beach, S.C.): "In our case, a successful total joint program begins with surgeon leadership. Having an experienced surgeon cra a clear protocol outlining the general formula for perioperative management sets the stage for success. Couple this with a cadre of total joint surgeons who buy into that protocol, and the program is nearly guaranteed to start out on the right foot. However, to ensure that the program main- tains quality and grows from its successful inception, an able, detail-oriented total joint coordinator is an absolute necessity. is person must be a skilled communicator, able to interface with patients, surgeons, OR staff and clinical staff both in the surgery center and in surgical offices. A good coordinator also can keep track of the numerous prereq- uisites that patients must have in place prior to surgery: medical optimization, lab stud- ies, home health arrangements, education, perioperative medications, physical therapy arrangements. e list can be daunting." 3. Andrea Lessner, BSN, RN. Total Joint Coordinator of North Valley Surgery Cen- ter (Scottsdale, Ariz.): "Payer contracts are essential for a successful outpatient total joint program, and the work needed to negotiate these contracts should not be underestimated. A surgeon interested in moving cases to an outpatient setting will test sending their inpatients home at 23 hours, 18 hours, six hours, while collecting complication and readmission data. is data will be essential when negotiating a contract that meets an acceptable margin. I have seen surgery centers invest in huge capital items prior to having any contracts in place or do cases with a contract that gives the milk and the cow away for free. Start with one contract, and take care of those patients how you would like to be taken care of, and build your database." 4. Brian Schwartz, MD. Orthopedic Sur- geon at Illinois Bone & Joint Institute: "I think the most important thing is patient selection. You need to have a healthy patient, a motivated patient, someone that has a good sup- port system at home that can help carry them through the first couple of days of recovery. en you need to have a good team around you. It starts with anesthesia and the surgeon, but it's also important to have a physical therapy team and a post-op nurse that's experienced in getting people up and moving right away. Also, a trusted, experi- enced home health RN and physical therapy team is an essential element to the process. We're trying to break down the culture that if you have your hip or knee replaced you need to be in the hospital for two or three days because that is definitely no longer the case. If someone is starting this de-novo, I would recommend to travel to a center that's been doing this for a long time and see in person the process from beginning to end. at way they're not reinventing the wheel from scratch because it's being done successfully across the country." 5. Louis Levitt, MD. Vice President and Secretary of the Centers for Advanced Orthopaedics (Bethesda, Md.): "I believe that orthopedics is leading the trend toward outpatient procedures. Ortho- pedic surgeons routinely perform complex surgeries in an outpatient setting, including joint replacements, ACL reconstructions and spinal fusions, to name a few. As a specialty, orthopedics is a leader in demon- strating how to take full advantage of the outpatient setting to maximize efficiency and improve the patient experience and outcomes." n Stryker, Wright Medical face FTC scrutiny over $4B merger: 4 details By Angie Stewart Stryker's proposed merger with Wright Medical is facing additional scrutiny from the Federal Trade Commission, a Jan. 2 SEC filing shows. Four things to know: 1. Wright Medical and Stryker announced in November that they signed a de- finitive agreement for the transaction. They filed notice with the FTC's antitrust division Dec. 16 of their intent to merge through a deal valued at $4 billion in total equity. 2. On Dec. 31, the companies each received a second request from the FTC, which extends the review period and typically seeks additional documents about company services, market conditions and likely competitive effects of the merger. 3. The additional hurdle comes as no surprise to analysts, who quickly predicted a challenge from the FTC due to Wright Medical's focus on lower extremities and small bones. 4. Stryker executives also indicated they were aware of potential obstacles. They predicted during a Nov. 4 conference call that the transaction won't close until the third quarter of 2020. "We have a lot of work to get through to close and integrate, and as I refer- enced before, we think the portfolios are highly complementary, but it is just premature to start talking about what products we may or may not discontin- ue going forward," said Katherine Owen, Stryker's vice president of strategy and investor relations. n

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