Becker's ASC Review

83 Executive Briefing: SPONSORED BY T he shift of total joints and orthopedic cases from the hospital to the ASC is becoming more predominant based on several driving factors such as increased surgeon autonomy, favorable outpatient payer policies, advances in medical technology, and improved health literacy among the patient population. Surgeons who were initially undecided are now looking for ways to capitalize on this shift. However, with all the critical requirements to establish a successful outpatient total joint program, many are left wondering where to begin. To better understand the driving factors for this shift and what is essential to establish a successful outpatient total joint program, Becker's ASC Review recently met with Nicholas B. Frisch, MD|MBA*, an orthopedic surgeon specializing in minimally invasive, complex and revision large joint replacement. Dr. Frisch was an early adopter of outpatient total joints; he was still completing his residency in 2012 at Henry Ford Hospital in Detroit, Mich.,when he began to realize the number of inherent benefits of performing total joint procedures in a freestanding surgery center. He began to lay the foundation for his own company during his fellowship at Rush University Medical Center in Chicago and opened his first ASC upon completion of his fellowship in 2017. Today, Dr. Frisch is involved in building, managing and operating many total joint-focused ASCs across the Detroit metropolitan area. A Win-Win-Win Scenario We asked Dr. Nicholas B. Frisch what makes total joint cases in an ASC more attractive than performing them in the hospital from the perspective of a surgeon, patient and payer. "From a surgeon's viewpoint, there are many advantages to operating in an ASC. First, there's the opportunity to be involved from a business standpoint. Speaking candidly, there are opportunities for physicians to partner with each other, management companies, or in my case my hospital that I'm affiliated with. So there's a financial benefit from that standpoint. From the other side of it, you have a lot more autonomy; for example, we use ROSA robotics in our ASC, but there have been some challenges implementing that in our hospital. For me it was only a two-week process to coordinate getting a ROSA with my other surgeons, and now I can use ROSA very easily in the outpatient setting. There's also a lot of freedom for how you want to schedule your cases, what you can do to create great patient experiences, and many other advantages related to the freedom gained by operating in an ASC. "There are also a lot of benefits from the patient's side, which has been an even bigger change with COVID. Everyone has their own approach, but my approach was you can either be operated on at the freestanding ASC and go home the same day, or you can be operated on at the hospital and go home the same day as well. This was largely a selection question for me because you had one group of people who would say, 'I definitely want to go to the hospital.' That was fine as it may have been the best option for them, but then on the other hand you had this group that would say, 'Oh no, I don't want to go to a hospital – I definitely want to go to the surgery center.' With COVID, the answer to that question has changed dramatically in the sense that most patients are actually coming in and asking to have their surgery performed in the ASC away from a hospital, before you can even discuss site-of- care options with them. "Lastly, we have the payers where we continue to see more push on the authorizations. They're saying if a procedure can be done in an ASC they want it to be done in an ASC, due to cost of care, reimbursement, great outcomes 1 , etc. "I think things will only progress further in favor of procedures being performed in an ASC versus a hospital, especially from the patient side where word continues to get out in the community as people go through the process and have such positive experiences, there's a positive shift culturally where people are just more open, interested and educated on the benefits of outpatient surgery being faster, more convenient and producing great outcomes. 1 I do not see any scenario where the shift to have more procedures done in an outpatient environment will go back the other direction; I believe it will only accelerate," said Dr. Frisch. The Mindset for Outpatient Success Ambulatory surgery centers are complex small businesses – each with their own unique challenges: lower reimbursements compared to hospitals and hospital outpatient departments, limited capacity for storage, staff and sterilization, and a plethora of workflows and communications that must be streamlined to ensure the ASC remains as efficient and profitable as possible. The goal is to combat these challenges all while delivering excellent patient care and improving outcomes. Even with a business degree and healthcare operations experience, all these added responsibilities can be daunting to a surgeon who traditionally has only been responsible for the clinical aspects of a surgery. We asked Dr. Frisch what advice he would give to someone who is responsible for bringing total joint cases to a new or existing ASC, or perhaps has already started their program, but is looking for ways to improve. "Surgeons need to be thinking about the things that are happening in the hospital that they don't normally see," he said. "Things like the physical therapy protocols, the Expert Advice on Performing Total Joint Cases in the ASC 1 Carey, K., et. al. (2019). Patient Outcomes Following Total Joint Replacement Surgery: A Comparison of Hospitals and Ambulatory Surgery Centers. The Journal of Arthroplasty. Volume 35 (Issue 1), P7-11. https://www.arthroplastyjournal.org/article/S0883-5403(19)30787-9/fulltext

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