OR Manager - February 2018 - 26

AMBULATORY
SURGERY CENTERS
costs to modify a surgery center for
total joints. " For some centers, these
may be minor because they are already
doing uni-compartmental knees or other
large orthopedic cases, and they already
have things like power equipment,
instruments, positioning devices, and
other equipment necessary for these
procedures, " Sparks says.
Scott Leggett
Other centers may be
starting from scratch
and will need adequate
power equipment, augmented
sterile processing,
a specific OR table,
and modification of a
private room or an area
in recovery designated for 23-hour
stays, according to Scott Leggett, comanaging
director of Convergent Same
Day Orthopedic Strategies, a consulting
firm. Leggett developed the consulting
company with his business partner Tom
Wilson to advise other ASCs on building
total joint programs based on the lessons
they learned at the ASCs they
manage in San Diego and Monterey,
California. Dr Kimball sits on the advisory
board of Convergent, whose mission
is to get surgery centers " joint
ready, " according to Leggett.
" There are so many aspects of total
joints that need to be addressed, " says
Leggett, who with Wilson also co-owns
Global One, a third-party administrator
for bundled payments in the ASC.
" We found that when we met with ASCs
about negotiating bundled payments,
very few had intentionally thought
through all the pieces, including negotiating
reimbursement. "
Return on investment is a factor
of facility need, size, number of total
joint surgeons, and capital investment,
Leggett says. Data collected at the facilities
Leggett and Wilson operate indicate
that with appropriate payer contracting
to ensure appropriate payment
and implant pricing, an ASC can annually
add as much as six figures to its
bottom line with as few as three to five
total joint arthroplasties per month.
26
OR Manager | February 2018
While awaiting future Medicare rulings
on coverage, surgery centers and
device manufacturers will continue to
negotiate reimbursement with commercial
payers. However, the cost savings
at surgery centers works both ways:
Although costs can be lower, so can reimbursement,
especially if commercial
payers reimburse at Medicare rates that
may not include carve-outs for medical
devices.
" Data collection will be extremely
important as we negotiate with payers, "
Leggett says.
The American Joint Replacement
Registry, the official registry of the
American Association of Hip and Knee
Surgeons, requests that ASCs performing
total joints submit their data to its
national registry at ajrr.net.
Establish protocols and
procedures
" The most successful ASCs doing total
joints are the ones that have evidencebased
programs and protocols in place
that everybody follows, " Leggett says.
" Unlike a hospital, at an ASC there's
no discharge planner or a department
that coordinates everything around the
surgery. You have to build your own
program using the staff you have, from
preoperative evaluation to managing
postoperative home health. These are
the issues that somebody else takes
care of for surgeons at the hospital. But
at an ASC, you either need to come up
with the protocols on your own or hire a
consultant to do it for you. "
At AMSURG, Sparks-along with the
company's physician advisory board
and selected physician champions-
developed a total joint implementation
guide that follows evidence-based best
practices and industry standards established
by AAAHC.
The Joint Commission has an orthopedic
certification as well.
" One of our first hurdles was developing
protocols to care for patients
staying overnight at our center, " Haller
says. " That's new for most ASCs. "
AAAHC creates
new orthopedic
certification for ASCs
The Accreditation Association for Ambulatory
Health Care (AAAHC) is rolling
out a new orthopedic certification program
for ASCs seeking to demonstrate
high quality of care and compliance with
rigorous industry requirements.
After an ASC has achieved overall
accreditation, it can acquire the certification
to demonstrate excellence in orthopedics
by meeting specific industry
standards. The requirements touch on
several aspects of the ASC orthopedic
specialty, including credentialing and
privileging of providers, rigorous prescreening
criteria to ensure optimal patient
outcomes, and clinical care based
on current evidence-based guidelines.
" AAAHC-accredited ASCs requested
an orthopedic certification to create
an organized structure that ensures
high-quality delivery of care and
strong patient outcomes in orthopedic
procedures, " says Tess Poland, MSN,
BSN, RN, senior vice president of
accreditation services for AAAHC.
The orthopedic certification program
standards and the 2018 Accreditation
Handbook for Ambulatory Health Care,
which includes updated standards for
2018 and the Centers for Medicare
& Medicaid Services' emergency preparedness
requirements, are available
at aaahc.org/publications. More information
is at aaahc.org/en/Certification/Program-Levels.
Establish
patient selection
criteria
" You need to develop your patient selection
criteria and stick to it, " Sparks
says. Standards for total joint patient
selection are more narrow than for
other surgeries performed in an ASC
because of the size, complexity, and
recovery time required for these cases.
www.ormanager.com
http://www.ajrr.net http://www.aaahc.org/publications http://www.aaahc.org/en/Certifica http://www.ormanager.com
OR Manager - February 2018

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