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Elective Surgery is Essential - August 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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A U G U S T 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 2 9 with patients and help guide them through the episode of care. They should expect to be more actively involved in all aspects of the patient's expe- rience from the moment their cases are scheduled to the last post-op rehab appointment. Joint replacement surgeons operating in acute care settings have not yet been able to experience the surgical efficiencies achieved in outpatient facil- ities that sports medicine and hand, foot and ankle surgeons have experienced for many years. They're beginning to realize they need to capitalize on the benefits of performing procedures in surgery cen- ters, which offer dedicated surgical teams and the possibility of buying facility ownership shares. Outpatient joint replacement programs therefore help you recruit surgeons and grow your business with revenue-producing cases. Do you have an episode of care model? I recommend forming a multidisciplinary committee comprised of the providers and personnel — sur- geons, anesthesia professionals, nurses, surgical techs, clinical managers and facility administrators — who will be involved in the joints program. Discuss all aspects of patient care and decide how you'll conduct staff education, select equipment and supply vendors and negotiate with insurers. It's important to carve out the cost of pricey implants in the facility fee you negotiate with insur- ers. If possible, have surgeons agree to use implants from a single manufacturer. Establishing a standard- ized option will give you more buying power and help you negotiate a lower price. Not long ago, vendors had doubts about the long- term feasibility of outpatient total joints. I've seen a shift in their thinking in recent months. Now, most vendors want to partner with facilities that perform one of outpatient surgery's hottest specialties and will offer very competitive implant pricing in exchange for a reasonable commitment of business. Work with the committee of caregivers to map out the specific elements of your clinical pathway and present it to insurers to show how you plan to care for patients effectively and safely. Also estab- lish clear and comprehensive discharge directives that help guide patients through their recoveries and post-op rehab routines. We have a nurse navigator who manages the care of all total joint patients. She quarterbacks our facility's protocols and processes, and guides patients through the entire episode of care. In addition, we use a patient communica- tion app to keep patients connected to their caregivers. The technology facilitates their com- pliance with pre- and post-op recovery protocols through automatically generated text or email alerts and reminders. It's been a great way to keep patients informed and satisfied with the care we provide. How will you screen candidates for surgery? Patient selection protocols will differ in individual facilities. In general, it should be based on the expe- rience and comfort levels of surgeons and anesthe- sia providers. Many facilities, including ours, accept only patients with BMIs of less than 35 and ASA classification of 1 or 2, which by definition means they have very few comorbidities. We also try to avoid patients with sleep apnea, uncontrolled dia- betes or bleeding disorders, as well as those who smoke, have substance use disorders or suffer from chronic pain management issues. A potential patient's self-motivation and support system are also very strong factors in successful outcomes. Even young, healthy patients who are physically active and present with no comorbidities aren't candidates for undergoing their procedures in our facility if they don't have a support system in place at home to help them recover. A big key to optimizing outcomes is patient preparation. Require patients to visit your center before their procedures to meet with members of the care team. Give them a tour of the facility so they know what to expect on the day of surgery. These site visits and face-to-face meetings have been beneficial in helping us set patient expecta- tions for same-day discharge and making sure they understand the importance of being active partici- pants in their care and the commitment it will take to achieve optimal outcomes.

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