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32 TOTAL JOINT SECTION Total Joint Replacement in ASCs: 10 Years & Counting for Pacific Rim Outpatient Surgery Center — 5 Things to Know By Mary Rechtoris M ichael orpe, MD, an orthopedic surgeon at Pacific Rim Out- patient Surgery Center in Bellingham, Wash., was one of out- patient total joint's early pioneers. Alongside fellow surgeons and anesthesiologists, he opened Pacific Rim Outpatient Surgery Cen- ter in 2003. e independent, for-profit ASC is currently comprised of nearly 45 shareholders. In 2005, Dr. orpe opted to move his cases out of the hospital aer un- successful negotiations with his hospital concerning ER call coverage in orthopedics and launched the center's total joint replacement program. He teamed up with the ASC's medical director, a triple board-certified anesthesiologist, to develop best practices and protocols aer reviewing national protocols. Here are five concepts that make Pacific Rim's total joint replacement program possible: 1. Payers are jumping on board. When Pacific Rim's total joints pro- gram launched in 2005, only one payer, Kaiser Permanente partner Group Health Cooperative was willing to work with the surgery center. e payer reviewed the ASC's protocols and saw the potential cost savings. In January 2014, Blue Cross Blue Shield began working with the ASC on its total joint replacement program. e number of payers continues to increase, espe- cially as more centers utilize bundled payments. "When bundled payments come, a payer would look at us and see that they can spend $30,000 for a total knee when it costs $60,000 or more at a hospital," says Dr. orpe. "Surgeons can actually start bargaining to get their fee higher. Orthopedics is lucrative right now for ASCs because you are doing bigger cases now that are reimbursed well." 2. Updated pain management protocols. Since the program took off, the ASC stopped using drains, femoral nerve blocks for knee replace- ments and staples on the skin, as well as decreased narcotic use. Dr. orpe uses Exparel/Marcaine mixture for pain control during the postoperative period. Patients undergoing a total joint procedure participate in physi- cal therapy beginning the night of surgery and the next morning prior to discharge, then at home through a home health agency. "I stopped using morphine in spinal blocks and now we use oral narcotics," Dr. orpe says. "e local hospital implemented a lot of what I had been doing at the surgery center. Our practices have dried along together." 3. Patients have a strong home support system. Outpatient total joint procedures require healthy patients with a strong support sys- tem to reap success. "We choose ASA class I and II patients, and sometimes we'll do a healthy III," says Dr. orpe. "You don't want a patient who isn't going to thrive post-op at home. You want them healthy and motivated." Prior to the procedure, the surgeon ensures a patient's home is suffi- ciently set up. A physical therapist will go to a patient's home preop if needed and postop until the patient can do the exercises themselves or travel to an outpatient facility. 4. Hiring and retaining dedicated staff. e ASC built a sup- port staff around Dr. orpe to focus on total joint replacements for maximum quality and efficiency. "You need a dedicated OR team to de- velopment a solid TJR program," Dr. orpe says. "You can't just have a fill-in team." Equipped with eight stage-one recovery bays, three pediatric recovery bays and five stage-two recovery bays, Pacific Rim Outpatient Surgery Center's patients recovering from a total joint procedure stay for just un- der 24 hours following the procedure. e ASC's team members are with the patient from the procedure through the recovery process to ensure the patient is recovering well. 5. Paving the way for other ASCs adding TJR. e program has served as a vital resource for other surgery centers interested in integrat- ing total joints into their repertoire of offerings. Since the program started, several surgery center staff members and surgeons from surrounding cit- ies including Mount Vernon, Renton, Richland and Everett, have visited Dr. orpe and staff members to learn about the center's total joint re- placement successes. "Outpatient TJR will continue to grow and grow until everyone is brave enough to do it," says Dr. orpe. "A lot of surgeons don't want to start, and that is because of strong hospital joint center programs already in place and many orthopedic surgeons are employed by the hospitals. ere is an unspoken disincentive there." n Flower Orthopedics Releases FlowerAdvantage Program Designed to Reduce ASC Cost of Care By Eric Oliver H orsham, Pa.-based Flower Orthopedics released its FlowerAdvantage Program, a multilevel initiative designed to reduce an ASC's cost of care. Flower Orthopedics based the program on four concepts to generate cost savings and impact ASC operations. The pillars are: • FlowerBucketPrice: Identifies, bundles and sells components for individual cases • Flower ECO Implant: Value-based implant portfolio capable of challenging reimbursement scenarios • FlowerBuyBack: Allows the surgery center to sell back Flower used single-use instruments • Flower Ready-For-Surgery: Eliminates operational costs associated with several factors. In a statement, Flower Orthopedics said the program al- lows centers to cut cost while still retaining the same level of patient care. n