Andrea Lessner, BSN, RN, total joint coordinator of Scottsdale, Ariz.-based North Valley Surgery Center — an HonorHealth affiliate managed by Sovereign Healthcare — told Becker's ASC Review about four key elements of a successful outpatient total joint program.
Note: Responses were lightly edited for style and length.
1. Payer contracts. "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, 6 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."
2. Surgeon leadership. "Surgeon leadership is not just surgeon buy-in, it is a commitment to building a program and having patience as the facility and staff experience growing pains. If you want to build a successful outpatient total joint program, you must have a physician leader who is a joint reconstruction specialist, specifically a surgeon that does 250-plus total joint cases a year. I would also recommend a surgeon who is collaborative and has a reasonable degree of patience."
3. Clinical pathways. "Clinical pathways need to be created through multidisciplinary collaboration, up-to-date practices and scheduled reviews. The pathways need to be a living document that maintains clinical relevance. I think about some of the things we did five years ago, and I laugh. Clinical pathways will serve you well, they will keep your outcomes consistent [and] reproducible and they are a valuable tool for process improvement.”
4. Quality. "The product of clinical pathways, surgeon leadership and coordinated care is quality. Every intervention, medication, protocol that we follow drives a specific outcome and amounts to great patient care. Delivering great patient care is actually really fun, and the value that is created when delivered will be noticed by both patients and payers, who have become savvy to site-of-care cost savings."
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