Becker's ASC Review

Executive Briefing: 104 Executive Briefing: "You have to have a detailed understanding and method of administering anesthesia in a standardized way," said Dr. Joyce. For outpatient surgery "patients have to participate in their care a few hours after surgery. That's done through anesthesia and your anesthesia team has to be a collaborator." The preoperative work with patients is more significant for outpatient procedures. Prior to surgery, patients and family members discuss the plan for returning home and learn their postoperative physical therapy regimen. The physical therapists' space attached to the ASC allows patients more convenient access to care. "They need to know how to take care of themselves at home. The therapists that we collaborate with really understand these patients in their home setting." The sterile processing department at the ASC also plays a critical role in the success of a total joint program. "Sterile processing has to be robust," said Dr. Joyce, so CJI built a sterile processing department that was similar to the hospital's department, with the same policies, procedures and standards of care. Among the first 300 TJA's patients at the surgery center, there were no hospital admissions and the current infection rate is well below 1 percent. The stellar outcomes and low infection rates at Lighthouse Surgery Center aren't an accident; Dr. Joyce and his partners put in 18 months of planning and careful research to develop the surgery center. "This isn't something you can do shooting from the hip," he said. "You can't avoid the long-term planning. We think outpatient total joints are an opportunity for better care and reduced healthcare costs, but we don't want to ruin it by making a mistake." Dr. Joyce said Stryker was helpful in planning out the sterile processing workflow and inventory management system at the ASC. Inventory management is different at an ASC because centers can't keep as many instrument trays on hand as hospitals do. "Stryker has a breadth of experience working with centers across the country, and as we started to face some of the development challenges of building an ASC, they were a point of contact for us to collaborate with other centers that faced similar issues," said Dr. Joyce. "We created a culture of collaboration where they helped us meet some of our design, billing and operational challenges. Stryker was instrumental in all phases of developing the ASC." A promising future When Dr. Joyce first began performing outpatient total joints, patients were skeptical. Now, patients are asking for surgery in the ASC. They are motivated to recover from surgery quickly and return to normal activity. "You can't deter a motivated patient," he said. "In sports medicine, if you have a motivated patient who wants to play basketball after ACL surgery, they can do it. The same thing is true for total joint patients. People now come in and tell us they are exactly the right person for an outpatient total joint." The motivated patients bode well for continued ASC industry growth. Dr. Joyce and his partners see the value in performing more total joints in a physician-owned setting. "Health organizations are getting very large," he said. "I think surgeons, who are ultimately face-to-face with patients and care for the patients, feel that our ability to dictate important elements of their care is being diluted by larger bureaucracy of the big organizations. With our ASC, we have operational control." A small group of owners hold decision-making power at the ASC, which allows centers to quickly decide whether to implement new technology. Big corporations have national contracts that may not allow surgeons to bring in new technologies. "There are a lot of avenues where innovation is found and brought to us, and we don't have a barrier to entry," said Dr. Joyce. "That's something we all believe in strongly, and if the technology is reasonably priced, we work with surgeons to bring it to the center and evaluate it. Our goal is to make surgeons' lives easier, and we can do that." Dr. Joyce is a paid consultant of Stryker's ASC business. The opinions expressed by Dr. Joyce are those of Dr. Joyce and not necessarily those of Stryker. Individual experiences may vary. n Stryker is one of the world's leading medical technology companies that offers innovative products and services in Orthopaedics, Medical and Surgical devices, Neurotechnology and Spine to help make healthcare better. Procedural volumes, particularly with total joints, have been migrating from the hospital outpatient department to ambulatory surgery centers (ASCs). With the potential to provide over $55 billion per year in healthcare cost savings in the U.S., this shift in site of care is expected to continue beyond the post-pandemic environment. To meet the unique needs of this emerging customer, Stryker launched an ASC-focused business in 2020. With thousands of unique and clinically proven products spanning more than 20 procedural specialties, a wide range of flexible financial options and teams who understand the ASC landscape. Stryker is committed to delivering tailored solutions for ASCs to achieve their mission and goals.

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