Becker's ASC Review

24 Executive Briefing: Executive Briefing: someone will always answer right away." 5. Don't assume the ASC has everything needed for the procedure, or your preference items. Hospitals often have multiple surgeons using the same equipment, but the ASC might not. "At the hospital, you assume they have everything," says Dr. Gleiberman. "At the ASC, they might not have your saws. You have to make sure they have everything you need there before scheduling the case." How to prepare the ASC Everyone from the scheduler to the nurses, physical therapists and support team should give patients a consistent and positive message about their procedures. "When my patients select out- patient surgery, they head down a different path to only meet with people who are doing outpatient procedures," says Dr. Berghoff. "There are no mixed messages. The staff are highly motivated to support the patients." It also falls upon the surgeon to coordinate postoperative treat- ment. "Most surgeons are used to having the hospital do every- thing, but when you are at the ASC you have to plan postoperative nursing and physical therapy and schedule that ahead of time," says Dr. Gleiberman. "That was more of the learning curve for me than the clinical technique." When patients realize more benefits from outpatient procedures, they're more likely to drive additional patient volume. "In my prac- tice, I've seen patients come back for additional procedures," says Dr. Berghoff. "I've done one of their knees, but now they want me to do their other knee or hip. They are happy with the procedures at the ASC." What the future holds There are a few roadblocks to bringing these patients into the outpa- tient setting — the biggest being payers. If a payer won't reimburse for procedures at ASCs, the patient will go to the hospital. But non- coverage could become a non-issue in the future. The potential is there for this technology in an outpatient setting to address three of the primary goals of healthcare: delivering better outcomes, higher patient satisfaction and at a lower cost. "I think total knee replacement in the ASC is going to become more and more common, and I think insurance companies are going to drive it to the point where they tell people if you want to have your surgery done at an ASC, they'll eliminate the copay or medication payment to incentivize the low-cost, high quality set- ting," says Dr. Berghoff. As more surgeons endeavor to learn new technologies and per- form total joint replacement in outpatient settings the best advice is consistent: seek out those who are already doing it, and learn from the best. "Take time out of your practice to visit the surgeon already doing it and get an idea of how everything works," says Dr. Gleiberman. "There is no sense in beating your head against the wall with com- mon issues if someone has already figured it out. That's better than starting on your own and running into headaches." n (Endnotes) 1 Cram, P.; "Total Knee Arthroplasty Volume, Utilization, and Out- comes Among Medicare Beneficiaries, 1991-2010"; JAMA; Sep 2012; V308(N12);pp.1227-1236 2 Ho, DM. Are Critical Pathways and Implant Standardization Programs Ef- fective in Reducing Costs in Total Knee Replacement OperaRons? J Am Coll Surg 2007" 3 Lombardi, AV; "Feasibility of Outpatient Arthroplasty; ICJR Winter Hip and Knee Course; Jan 2014; http://icjr.net/meeting/agenda.49.htm 4 Kurtz, et al; In Vivo Kinematics for Subjects Implanted With Either a Tradi- tional or a Customized, Individually Made TKA. ICJR Pan Pacific 2014 Annual Meeting, Abstract # O21A2 5 Cates, et al; In Vivo Kinematics for Customized, Individually Made vs. Off- the-Shelf TKA During a Deep Knee Bend and Chair Rise. ICJR Pan Pacific 2014 Annual Meeting, Abstract # O11A2 6 Ramos, et al; Correlation Between Physician Specific Discharge Costs, LOS, and 30-Day Readmission Rates: An Analysis of 1,831 cases. Journal of Arthro- plasty; 2014, 29 #4: 674-677 7 Culler, et al; Hospital Outcomes and Cost for Patients Undergoing a Custom- ized Individually Made TKA versus an Off-the-Shelf TKA; ICJR Pan Pacific; Jul 2014; https://icjr.net/meeting/agenda.33.htm 8 Mahoney, et al; Overhang of the Femoral Component in Total Knee Arthro- plasty: Risk Factors and Clinical Consequences. The Journal of Bone and Joint Surgery; 2010, 92: 1115-1121 9 Culler, et al; Hospital Outcomes and Cost for Patients Undergoing a Custom- ized Individually Made TKA versus an Off-the-Shelf TKA; ICJR Pan Pacific; Jul 2014; https://icjr.net/meeting/agenda.33.htm 10 Kurtz, William; Patient-Specific Knee Replacement Implants Preserve Bone and Decrease Blood Loss & Swelling. BASK Annual Meeting 2013, Poster #0138 11 Kurtz, William; Patient-Specific Knee Replacement Implants Preserve Bone and Decrease Blood Loss & Swelling. BASK Annual Meeting 2013, Poster #0138 12 Walers TS, et al.; "Analysis of procedure-related costs and proposed bene- fits of using paRent-specific approach in total knee arthroplasty"; J Surg Orthop Adv; 2011 ;V20:pp. 112–116 ConforMIS, Inc. is a privately-held medical device company that is pioneering a patient-specific approach to orthopedic implants. ConforMIS' partial and total knee replacement solutions, iUni® G2, iDuo® G2 and iTotal® G2, are individually designed for each patient. Potential advantages compared to traditional off-the-shelf implants include faster recovery time, shorter hospital stay, less blood loss, greater hospital efficiencies, and better clinical out- comes. ConforMIS products are provided in a pre-sterilized single package delivery system that can help hospitals reduce costs and treat more patients by reducing instrument re-sterilization costs and shortening set-up, procedure and turnover times.

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