Inpatient orthopedic procedures can safely migrate to the ASC setting if postoperative pain management and monitoring are extended by at least 24 to 48 hours, according to an article published by American Academy of Orthopaedic Surgeons.
Practices considering shifting procedures to ASCs should explore three models, said authors John C. Steinmann, DO, Alexander Sah, MD, Angela Carlson, Michael Bergerson, and Basil Besh, MD.
The authors suggest the following models:
1. Postsurgical recovery care center or convalescent care center. Arizona, Connecticut, Colorado and Illinois have established clear RCC licensing standards for extending monitoring and pain management. Colorado's ASC and CCC regulation models set a good example for orthopedic groups interested in pursuing RCC/CCC licensure. Fort Collins, Colo.-based Orthopaedic and Spine Center of the Rockies adopted a successful ASC/CCC model. It reported an average length of stay in its CCC of 1.05 days, significant cost savings and patient satisfaction rates between 95 percent and 98 percent.
2. Medical hospitality suites. Medical hotels for orthopedics provide recovery under supervision of licensed nursing staff in patient-centered environments. This model may work best for practices in states still seeking RCC/CCC licensure. Practices exploring this model should ensure only appropriate patients are chosen and that rooms have safety features including licensed nursing staff, generator backup power and basic diagnostic and resuscitative equipment. Arrowhead Orthopedics in Redlands, Calif., uses the MHS option.
3. ASC-licensed pain management and recovery care center. Practices could also license a second ASC as a PM/RCC under a state's State Health and Safety Code. With the licensed and accredited ASC ensuring quality standards, a PM/RCC ASC may provide certain services and private recovery rooms for orthopedic ASC patients.