FEATURE
SPECIAL FEATURE— CLINICAL EXCELLENCE
arm is basically in his operating room the entire day. We happen to have three C-arms readily available, so it is not an issue for us to leave it just in that room for him to use.”
Caption to come. Lenia adi as eum explabore, aut. Pari aut quat estectur?
Adding Hip Arthroscopy
How to determine if this procedure is a good fit in your ASC. BY ROBERT KURTZ
I
f an ASC includes orthopedics in its specialty mix but does not in- clude hip arthroscopy on its proce- dure list, now is a good time to ex- amine whether the surgery should be added, advises Stephan Pro, MD, an orthopedic surgeon at Lawrence Surgery Center in Lawrence, Kansas, who has performed hip arthroscopy in ASCs for the past three years. “From a future planning standpoint,
it behooves an ASC to look into hip ar- throscopy as a possible procedure,” he says. “It seems to be where shoulder arthroscopy was 20–30 years ago. It is a relatively newer procedure and the tech- niques we can use for hip arthroscopy are still expanding. It is only going to grow in terms of frequency and indications.”
Numbers Game Adding hip arthroscopy is not likely to be as easy as adding other orthopedics procedures for a number of reasons,
notes Patrick Lynch Jr., MD, an orthope- dic surgeon with Northwest Orthopae- dic Specialists in Spokane, Washington, who has performed hip scopes at The Orthopaedic Surgery Center since 2005. One of the most significant consider- ations is cost. “Just like adding any procedure,
you need to justify its capital outlay if you want to pursue it,” he says. “Hip arthroscopy is probably one of the most capital intensive, short of spine surgery, that an ASC could pursue.” Hip arthroscopy is a C-arm inten-
sive procedure, notes Jim Webster, administrative director of The Ortho- paedic Surgery Center, so your ASC will not only need the C-arm but must also be able to afford to devote the sur- gery system to the procedure. “If you don’t have a C-arm, that is an impor- tant consideration as it is a significant investment,” he says. “On Wednesdays, which is Dr. Lynch’s hip scope day, a C-
18 ASC FOCUS NOVEMBER/DECEMBER 2013
In addition to the C-arm, Lynch says ASCs will need to invest tens of thou- sands of dollars in other tools needed to perform hip arthroscopy, including a hip positioning/distraction system, scopes, shaver blades, cannulas and trays. The good news is your ASC does not necessarily need to purchase all the equipment outright, Pro says. “The up- front capital costs of that equipment are high, so our ASC in Lawrence has a rent- to-own arrangement.” Another important aspect your ASC will need to research is reimbursement and whether it makes financial sense to perform the procedure in your surgery center, Pro says. “You would use similar criteria for how you determine where to perform other complex orthopedic pro- cedures. ASCs can sometimes struggle with the procedure if they have payers in their market who do not pay additional for implants.” Lynch agrees. “As far as location of
where the procedure is performed, that is all dictated by insurance carriers,” he says. “We are, as anybody would be, watching our dollars. We are very sym- pathetic to our community here in Spo- kane, and we make sure these surgeries are done in the location—everything else being equal—that is the most eco- nomical for the patient. Fortunately, the hospitals still provide great facilities for me for when I cannot perform a proce- dure in an ASC.”
Not all procedures performed at The
Orthopaedic Surgery Center are covered by insurance, so to help patients without insurance financially plan for their sur- gery, the ASC now lists prices for more than 30 procedures—including hip ar- throscopy—on its web site, Webster says. “If you are not covered by insurance, we can give you an all-inclusive rate.” One final critical figure your ASC will need to assess is whether there is
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