replacement patients in the 1990s was 2 weeks.
• Bundled payments. If you don't know down to the dollar what
each joint replacement patient costs, you'll almost surely struggle
with the bundled payment model (See "Keeper of the Bundle" on
page 41). If you know exact costs, you'll know where to cut costs.
Too many RNs in PACU? Implant costs too high? Does that antibiotic
cement really reduce infections? Do you need that second dose of
antibiotics in PACU? Why give Lyrica when you can give gabapentin?
Why give acetaminophen IV when you can give Tylenol orally with a
sip of water? Why give Exparel when you can give bupivacaine?
Reducing costs in post-acute care is also key. You can do the most
efficient surgery, but you have to make sure you're doing it safely. If
your patient gets readmitted post-op day 3 with an embolism, you just
lost all of the profit in
the bundle for the
next 20 patients. At-
home physical therapy
and home health aides
don't improve out-
comes, so why pay for
them?
OSM
Dr. Courtney
(p.maxwell.court-
ney@gmail.com) is a
hip and knee replace-
ment surgeon at
Rothman Institute,
Thomas Jefferson
University Hospital in
Philadelphia, Pa.
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