Here are three key insights to establishing an outpatient total joint program at ASCs from experts interviewed by Becker's ASC Review:
1. Cami Love, administrator at the Arkansas Specialty Surgery Center in Little Rock:
"From start to finish, the biggest hurdle was payer contracts. Trying to get them worked out was a big challenge. We're in a state that is pretty much ruled by Blue Cross Blue Shield, and they tend to ride on Medicare's coattails.
"For ASCs wanting to start their own programs, I would start with letting your medical director take the lead. I also think having anesthesia involved from the very beginning is very important as well. Inclusion and exclusion criteria is also key. You have to have healthy patients, or they're not going to have a good result."
2. Carolina Bone & Joint Surgery Center administrator Georgia A. Kapshuck:
"In our case, a successful total joint program begins with surgeon leadership. Having an experienced surgeon craft a clear protocol outlining the general formula for perioperative management sets the stage for success. Couple this with a cadre of total joint surgeons who buy into that protocol, and the program is nearly guaranteed to start out on the right foot.
However, to ensure that the program maintains quality and grows from its successful inception, an able, detail-oriented total joint coordinator is an absolute necessity. This person must be a skilled communicator, able to interface with patients, surgeons, OR staff and clinical staff both in the surgery center and in surgical offices. A good coordinator also can keep track of the numerous prerequisites that patients must have in place prior to surgery: medical optimization, lab studies, home health arrangements, education, perioperative medications, physical therapy arrangements. The list can be daunting."
"Payer contracts are essential for a successful outpatient total joint program, and the work needed to negotiate these contracts should not be underestimated. A surgeon interested in moving cases to an outpatient setting will test sending their inpatients home at 23 hours, 18 hours, six hours, while collecting complication and readmission data. This data will be essential when negotiating a contract that meets an acceptable margin. I have seen surgery centers invest in huge capital items prior to having any contracts in place or do cases with a contract that gives the milk and the cow away for free! Start with one contract and take care of those patients how you would like to be taken care of and build your database."