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19 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine – Call (800) 417-2035 S uccessfully performing total joint re- placement surgeries in ambulatory sur- gery centers requires establishing and ob- serving criteria for appropriate patient selection. Here, three orthopedic surgeons discuss patient selection for TJR procedures in outpatient set- tings. Q: What kinds of patients are best to bring in for total joint replacement proce- dures in an ASC? Matthew Riordan, MD, Klasinski Clinic (Stevens Point, Wis.): Healthy and well motivated! The sur- geons and clinic staff deter- mine whether the patient is motivated and prepared. We generally assign pre-op clearance to our medical director who is also our anesthesiologist and an ASC partner. He is appropriately incentivized to identify those patients who are healthy and likely to do well. Thomas Eickmann, MD, of Cornerstone (Colo.) Orthopaedics & Sports Medicine: Patient selec- tion criteria are based largely off health status. I, as a surgeon, determine American Society of Anes- thesiologists classification for each patient. An ASA 1 is a healthy patient. An ASA 2 is a patient that has some medical prob- lems that don't interfere with their life. ASA 3 is a patient that has medical problems that interfere with their life. We extensively screen our patients and allow only ASA 1s or 2s. We also would not perform surgery on people who have arrhythmia or are taking blood thinners. I have an anesthesiologist that works at the center and helps screen patients. Sometimes the anesthesiologist will screen out a patient I think is okay. I can't stress enough how important it is to collaborate with an anesthesi- ologist looking out for potential health problems that might derail you. Robert Hartman, MD, Minnesota Valley Surgery Center (Brunsville): The optimal patient for an outpatient total joint procedure is a young, active individual with few or no medical comorbidities, a willing and understanding spouse or significant other at home, and a BMI under 40. Medicare does not recognize outpatient total joint surgery other than partial knee replacement, therefore, with the exception of partial knee replacement, Medicare patients are excluded by definition. Q: What precautions or concerns do phy- sicians have regarding this procedure in an outpatient setting? TE: The biggest impediment of all has been the contractual relationship the ASC has with its pay- ers. Getting those contracts in place is the chal- lenging part and can take a long time. Payers are Total Joint Replacement Patient Selection in ASCs: 3 Orthopedic Surgeons Discuss By Brandon Howard Frank Chapman, MBA Chair, AAAHC Board Our surveyors are active health care professionals. They bring 'real world' understanding to the process. Choose the Leader in Outpatient Surgery Accreditation. With Standards that are nationally recognized and annually reviewed, AAAHC accredits more than 6,000 health care facilities. Our surveys are collaborative by nature and not just a checklist. And we match our surveyors' credentials as closely as possible to your speciality. " For more information, Contact us: 847-853-6060 By email: info@aaahc.org Log on: www.aaahc.org " Improving Health Care Quality through Accreditation