Last year, Rockford-based OrthoIllinois Surgery Center integrated total joints into its repertoire of offerings, making the center one of the first ASCs in Illinois to add the service line. The center's team of orthopedic surgeons has performed nearly 12 procedures to 15 procedures within the year, and has already experienced the benefits total joint offers.
However, total joint was one of the later specialties to makes its way into the outpatient arena, which may draw skepticism from many in the medical community.
"Everyone used to be hesitant about doing pain management," says Michael Chmell, MD, an orthopedic surgeon with OrthoIllinois. "I think back to when I started, and ACLs were only done in a hospital. Now, there is not a second thought to doing them at surgery centers."
Few aspire to be pioneers in the medical field, as being among the first to add TJR carries an element of risk. To be successful and yield superior patient outcomes, ASCs have several considerations.
Here are four key thoughts on adding TJR:
1. Patient selection. First and foremost, patient selection is of the utmost importance, as older patients are not ideal candidates for outpatient TJR. Dr. Chmell explains the procedures are intended for a limited number of patients who have to be motivated to succeed. For instance, patients have to be willing to attend pre-operative meetings to learn about pain management, the procedure and ensure their home is sufficiently set up for the recovery process. OrthoIllinois makes sure patients have a person to stay with them for several days following the procedure, and advises this 'coach' to attend pre-operative meetings with the patient.
When surgery centers do select the right patient for the procedure, the outcomes may equal or even surpass hospital outcomes due to the lower risk of infection, and patients are overall more satisfied, Dr. Chmell says.
"More and more outpatient total joints will be done at ASCs," he adds. "I do think it needs to be slow in case there are some stumbling blocks or inappropriate patients are done that could hurt the future chances of Medicare approving joints."
2. Working efficiently with an ASC's staff. Surgery centers allow physicians more flexibility in case load and amount of time in between cases. Additionally, the same qualified individuals staff the center, so physicians becomes comfortable with the people they work with each day.
"In our surgery center, physicians have better efficiency with the staff, " Dr. Chmell says. "You work with people you are familiar with, as opposed to in an hospital where each case seems like it is the first time being done."
When integrating a TJR program into an ASC, centers should ensure their multiple surgeons performing the procedures have similar protocols, so patients and staff have a consistent message.
3. Developing an outpatient TJR program in a hospital. To get payers onboard with a TJR program in an ASC, Dr. Chmell advises centers first implement a program in a hospital to illustrate how outpatient TJR yields equal, if not better, patient outcomes. OrthoIllinois first developed a program in a hospital to provide its major non-Medicare payer data showing the program's safety and efficacy.
"When developing the program in a hospital, it was huge to show the payer here is the plan for the procedure, and beyond in terms of home care and physical therapy," Dr. Chmell says.
4. Why TJR is late to jump on the outpatient bandwagon & where it is headed. ASCs can safely perform many procedures on an outpatient basis, but may not be financially able to add some services based on reimbursement. If a procedure does not have an approved code, the ASC can lose financially, thus threatening its sustainability in the competitive healthcare landscape. However, although TJR doesn't have a code right now for ASCs, Dr. Chmell believes that could change.
"I am hopeful as more ASCs do total joints and have data showing cost savings, it would be foolish not to add a code," he says. "With Medicare bundled payments, that will be another potential opportunity to move cases to the surgery centers, as they provide additional cost savings."
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