Becker's Spine Review

52 OUTPATIENT SURGERY Hospital for Special Surgery Plans Fall Opening for Surgery Center — 3 Insights By Eric Oliver N ew York City-based Hospital for Special Surgery believes its 50,000-square-foot center will be complete this fall, Westfair Online reports. Here's what you should know: 1. The center will be HSS' largest outpatient center. 2. HSS did not reveal the total cost of the project. 3. The center will offer rehabilitation services and performance-based physical therapy. The center will also offer X-ray and MRI services. n Florida's 1st Freestanding ASC is Closing: 4 Key Notes By Mary Rechtoris H ollywood, Fla.-based Memorial Same Day Surgery Cen- ter is closing its doors at the end of August, according to Sun Sentinel. Here are four key notes: 1. Twenty-six physicians opened the ASC in the early 1970s. 2. Competition in the area is increasing, leading the ASC to close its doors. Many local surgeons are performing cases in hospi- tal-owned and insurance company-owned facilities. 2. Memorial Same Day Surgery Center was the first freestanding ASC in Florida. 3. Currently, 40 local surgeons and a financial investor own the ASC. 4. The owners plan to transfer a substantial percentage of the ASC's cases and employees to a different facility, which is a part of Pembroke Pines, Fla.-based Memorial Hospital West. n Is Outpatient TJR the New Frontier for Orthopedics? 4 Surgeons Discuss By Anuja Vaidya F our total joint replacement surgeons weigh in on the trajectory of total joint procedures in the outpatient setting. Question: In what ways will outpa- tient TJR evolve in the next five to 10 years? G. Daxton Steele, MD. Total Joint Replace- ment Surgeon at Andrews Institute for Or- thopaedics & Sports Medicine (Gulf Breeze, Fla.): I'd say we're still in the learning phase in regards to outpatient total joints. ere are some physicians that will continue to push the envelope, and some physicians will sit back and wait to see what develops. Over the next five to 10 years we should learn a lot more about who are the optimal patients that we can perform total joint surgeries on in an outpatient setting and those for whom it's not quite as safe or optimal to do so. Michael J. Chmell, MD. Orthopedic Sur- geon at OrthoIllinois (Rockford): Depend- ing on our government, and what happens with Medicare, I would foresee up to 50 percent of TJR done on an outpatient basis 10 years from now. I expect the rapid evo- lution in anesthetic and pain management techniques that is occurring now to continue, resulting in even better outcomes and more outpatient TJRs in the future. Matthew S. Austin, MD. Adult Recon- struction Division Chief and Adult Recon- struction Fellowship Director at Rothman Institute (Philadelphia): e practice of evidence-based medicine has shortened TJR patient average length of stay to well under two days and patients are going home safely, without the hassle or additional cost of un- necessary post-acute care. Cost curves have been driven down as a result but are flattening, or will flatten, in the near term. ere is a finite amount to what can be saved until further clinical advancement is realized and regulations change. Outpatient joints are being touted as the next frontier for savings, but few surgeons are comfortable performing them in surgery centers, favor- ing instead the outpatient hospital setting as the test environment and really only for the healthiest patients. Moreover, only 15 states have 23-hour stay rules in the outpatient set- ting which makes regulation a roadblock to potential advancement. Even CMS is unsure of a wholesale removal of TJR from its inpa- tient-only procedure list, and is considering only the removal of TKA aer additional study. Value-based care has been validated by its co- ordination of the interests of patient, provider and payer, and further by its ability to realize improved quality of care at lower costs. Con- tinued advancement, however, needs delib- erate execution to continue forward without steps backwards. Jeffrey C. Davis, MD. Orthopedic Surgeon at Andrews Sports Medicine & Orthopae- dic Center (Birmingham, Ala.): I anticipate continued growth in certain markets and im- proved protocols to insure safety and success. e model of joint replacement continues to go away from "sick model" to "well model" and the outpatient TJR trend will certainly accelerate this change. Continued improve- ments in multi-modal pain management and rehabilitation both before and aer the proce- dure would be expected. Some modification of approaches and event implants is likely to occur during this time frame. n

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