Start posting patients for knee and hip replacements! Furthermore, send them home in less than 24 hours directly from your surgery center. No 72-hour-stay facility is needed.
We’ve been doing total knee replacement for years in ambulatory surgery centers (ASCs) and sending patients home after 23 hours. It’s common. Now, enter a new procedure: hips!
The level of excitement of adding these procedures to your daily schedule for the average surgery center is, well, phenomenal to say the least. The average facility does not start doing these right away without taking the right steps. Some of the major steps include:
- The right surgeon. It takes a surgeon who is committed to making this work in a freestanding ASC. It truly takes an orthopedic surgeon who is very experienced, proficient in these procedures, and wants to move the patient from the hospital to the ASC to add this level of cost control and increased patient satisfaction over these cases.
- The right patient. Patient selection is a large part of the process. From an acuity standpoint, we calculate that, on average, 20% of the patient base is not appropriate to have these procedures performed on an outpatient basis.
- Medicare approval list. These procedures clearly are not on the Medicare approval list for outpatient surgery and, thus, no patients from federal payers are allowed. Sound familiar? We never thought we would be doing spinal fusions and laminectomies in our ASCs, and Medicare added nine spine cases for ASC reimbursement in 2015. So…
- Equipment. Not a lot of extra equipment is needed for most facilities doing high-end orthopedic cases, but significant surgeon-specific instrumentation is needed.
- Costs. Implants are neither free nor cheap. Figure four to six grand for the knee or the hip.
- Profit. The profits vary depending upon how you are set up with your contracts. Conservatively, the profits run about $13K after expenses for either procedure in network. Out-of-network payments are significantly higher.
- Time. The average length of the procedure is about 45 minutes with a highly experienced surgeon.
- Training. Patient training starts in the ASC before discharge. Staff training is a large part of the success of your program.
- These are the high points. Talk to your ortho docs to gauge their interest, or start talking to orthopedists outside your facility. It’s a great way to attract them! (For more information on hip replacement, see “Hip surgery moves to outpatient arena — Shorter recovery with minimally invasive approach,” Same-Day Surgery, February 2004.)
Next month: Are referrals drying up for your ENT, orthopedics, and other procedures? Has the local hospital been culling away your primary care referrals? Try creating your own referral base with a simple, but proven, method. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates’ address is 5114 Balcones Woods Drive, Suite 307-203 Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. E-mail: [email protected]. Web: www.earnhart.com.]
Start posting patients for hip replacements and send them home in less than 24 hours directly from your surgery center. No 72-hour-stay facility is needed.
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