Surgeons at Orthopedic & Sports Institute of the Fox Valley in Appleton, Wis., needed to take at least five steps before they could move total joint replacements from the hospital to its ambulatory surgery center, which is co-owned by seven surgeons and an anesthesiologist. Aaron Bleier, finance manager of the practice, identifies the steps.
1. Take advantage of Medicare change. In 2008, Medicare began covering partial joint procedures on an outpatient basis. Private payors followed Medicare's lead, making it easier for them to take the next step and cover total joints, Mr. Bleier says. Before starting total joints at the ASC, the institute began to host partial joints there.
2. Arrange for an overnight stay. While some ASCs send patients home the day of a total joint replacement, surgeons at Fox Valley preferred to keep them in an overnight facility. The surgeons decided to use a skilled nursing facility for recovering patients. At first, patients recovering from total joint surgery were transported by van to an existing nursing home nearby. Then the institute built its own $3.8 million skilled nursing home for them, called Recovery Inn, which opened last August.
3. Get implant discounts. Seeking leverage in upcoming payment negotiations with private payors, the institute sought discounts on implants with vendors. However, the Institute did not require its orthopedic surgeons to align with a certain device. "We wanted the surgeons to have the freedom to use the implant they wanted," Mr. Bleier says. They still got a discount. "The vendors were willing to provide a discount to the ASC because they understood that in the long term the ASC is where these procedures are going to be done," he says.
4. Negotiate a carve-out with payors. Since private payors followed Medicare's policy not to cover total joints, the ASC had to negotiate a carve-out with payors. The center could point to lower costs due to better implant prices as well as the added efficiencies of an ASC. They could also point to patient safety provided by the Recovery Inn and to the overall trend. "The fact that Medicare approved outpatient coverage for partial knees in 2008 made private payors more comfortable with the idea of total joints," Mr. Bleier said. But acceptance is still slow. While national carriers have agreed to cover outpatient surgery for total joints, carriers based within Wisconsin have not.
5. Help patients feel comfortable. It took some education to help patients get comfortable with total joints in an ASC. "When they were getting a total joint, they assumed they'd be going to the hospital for a few days," Mr. Bleier said. Moreover, many of them did not like the idea of a "nursing home," even though it is only for orthopedic patients. But ASC staff have helped patients get used to the new situation by taking scheduled patients on a tour of the Recovery Inn and letting them see their room. The patients learned they would not always get a private room in the hospital but they would in the Recovery Inn. Patients still have the option of going to the hospital if they want to, and some do.
The transition to total knee at the surgery center was a needed boost for the ASC, Mr. Bleier adds. Just when the ASC was experiencing the brunt of the recession in 2010, it was buoyed by the new volume from total joints.
Learn more about the Orthopedic & Sports Institute of the Fox Valley.
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