Becker's ASC Review

24 Executive Briefing Sponsored by: D uring the coronavirus pandemic, many orthopedic practices and ASCs temporarily halted elective procedures and transitioned to telemedicine for weeks, or months, until it was safe to resume procedures. The American Alliance of Orthopaedic Executives reported that orthopedic practices on average dropped from 700 elective procedures per month to 273, a 61 percent decrease. Elective surgeries typically comprise around 73 percent of orthopedic practice volume and represent around $332,197 in monthly revenue; postponing those procedures has put significant financial strain on organizations across the nation. However, many states are moving past the estimated peak of the COVID-19 pandemic and beginning to lift bans on elective procedures. Orthopedic surgeons are adapting to address their backlog of cases by utilizing ASCs and specialty hospitals as safe and efficient sites of service for patients who are good candidates for outpatient procedures. Most ASCs did not care for COVID-19 patients, which makes them easier to reopen for non-coronavirus care. "The general hospitals are still so burdened by COVID-19 and patient stigma about not knowing whether they want to have their procedures in the hospital," said Dr. Sridhar Durbhakula, MD, an orthopedic surgeon at OrthoBethesda in Bethesda, Md. "ASCs will play an important role in resuming elective surgery because they can be up and running sooner than hospitals. The patient comfort and nimbleness of ASCs also make them ideal for total joint arthroplasties." Patients have also become more skeptical of hospitals and weary of long stays due to the risk of exposure to infectious diseases; often they'd rather have surgery at a surgical center and then recover at home if possible. With that in mind, ASCs and specialty hospitals are instituting extended hours and adding weekend OR time to care for as many patients as possible in the coming months. "The pandemic will potentially accelerate the pace of technology adoption in joint arthroplasty because there will be a focus on efficiency and supply chain, and enabling technology has the potential to benefit both areas," said Michael Ast, MD, an orthopedic surgeon at Hospital for Special Surgery (HSS) in New York City. "You can also achieve more predictability with these types of technology, including OrthAlign, and they have downstream supply chain benefits, such as decreasing the number of trays needed for each case, as well." OrthAlign offers single-use, disposable hand-held surgical navigation for knee and hip replacement surgeries that can help surgeons achieve more precise, accurate and predictable results. The KneeAlign device can be used with any knee implant system and provides data to ensure surgeons accurately cut the distal femur and proximal tibia as well as gap balancing data to guide intra-operative decision making for knee stability. Surgeons can also use the HipAlign system to with any hip implant or surgical approach for intraoperative acetabular component placement and leg length verification; it also tracks pelvic motion during surgery and displays pelvic tilt information. During this time, it is more important than ever for surgery centers to operate at top efficiency and provide high-quality care as the nation eases into the "new normal." Tech to support total joints in ASCs Technology will play a big role in the elective surgery ramp-up, both in clinical care as well as operationally. Surgery centers need technology that will fit seamlessly into their workflows to address inefficiencies in the supply chain, sterilization and patient discharge. Some ASCs may not have been originally built for total joints, which take up more space than other lower acuity procedures, and even centers built with those cases in mind will face new space constraints as providers stock up on PPE and other necessary equipment. "ASCs don't typically have the capacity to deal with nine trays and complicated room turnover. They benefit from technology that integrates easily and will be able to adopt to their individual center's capacity," said Dr. Ast. "Surgery centers will also have financial considerations when purchasing new equipment. Some will not be able to afford a huge capital outlay for technology like robots, and instead will opt for single-use, patient matched technology or handheld navigation systems that make sense on a cost- per-case basis." The most valuable technology will have both clinical and operational benefits, contributing to positive patient outcomes and lowering overall costs. Dr. Ast said that at his previous surgery center the surgeons collectively decided on the technology that would be most useful for workflow optimization in a limited space and utilized that technology to better streamline their cases. "Using standardized technology for knee replacements allowed us to get our vendors down to three trays total," he said. "That enabled more simplified processes and sterilization for outpatient cases. Everyone saw the real Total joint replacements in ASCs during the pandemic: Key technology and concepts for success

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