Boston Out-Patient Surgical Suites Administrator Greg DeConciliis detailed how the center established its total joint program, and trends and goals for ASCs moving forward.
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Note: Responses have been edited lightly for clarity and style.
Question: Boston Out-Patient Surgical Suites was the first freestanding ASC in Massachusetts to offer total joint replacements. What advice would you give to other ASCs looking to start their own programs?
Greg DeConciliis: My advice for facilities is not to just jump in to this thinking it's just adding another service line. [ASCs] should be sure that they have done an accurate facility assessment, and make sure everyone is on board with this huge undertaking. [They then should] put together a group of all the key stakeholders, including surgeons, anesthesiologists, nurses and administration. [and have that group] develop a clinical pathway on how [the center is] going to take the patents through the facility, all the way from patient selection to home care and follow-up appointments. I always suggest to reanalyze the clinical pathway plan as well; we did it after 10 procedures, asking ourselves "What are we doing right, what are we doing wrong and what can we improve upon?"
You also have to establish standardization with equipment and vendors and implant type, if possible, as well as work with the insurance companies to get reimbursed. In Massachusetts, we're the only ASC that has its own fee schedule, and in order to meet with them and have them approve it, they had to go over the clinical pathway. That's why I advise completing the clinical pathway right off the bat when establishing a program.
Q: What are your goals for the total joint program moving forward? What obstacles have you faced?
GD: One of the biggest obstacles was scheduling the patients, as well a patient awareness and desire to do the outpatient surgery because it's not the norm in this area. We usually do [total joints] in the morning, so moving forward we'd like to make sure we have ample block time as we get a more consistent volume. We're hoping [outpatient total joint procedures] become a more common, more accepted care plan for our patients.
Moving forward we're hoping to double our operating room capacity as part of an expansion in anticipation of outpatient joints taking off.
Q: As the Massachusetts Association of Ambulatory Surgery Centers' president, how do you advocate for the needs of ASCs in the state?
GD: Massachusetts is a very tough state to have an ASC because we're such a hospital-driven healthcare community. Oftentimes, the hospitals have political ties and strength with the insurers, so our strategy for years has been to stay under the radar. We don't want to make too much noise, because we've found that whenever things are beneficial for ASCs, the hospital associations get word of that and we weren't successful in fighting those political battles.
We recently had a 6 percent ASC tax proposed, so we hired a PR firm, and we did a lot of media outreach to talk about the benefits of the ASCs and how harmful the tax could've been, which was that it could have shut down many of the ASCs in the state. We have a more prominent seat at the table than what we had in the past.
Massachusetts is also a very referral-driven market, and a lot of patients are steered toward back toward the hospital systems, which is one of the obstacles we face more and more over the past few years.
Q. How do you see the ASC landscape changing moving forward?
GD: In my opinion, the ASC landscape will be kind of flat. I don't see many more ASCs coming about as hospitals develop more outpatient facilities. As far as the national climate, i would say Massachusetts is on par with that.