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COVER STORY Asher’s ASC does not currently


have a lot of provisions for situations when patients need to stay longer than 24 hours, he says. “When these rare situations arise, we document in the medical record the circumstances pre- venting discharge and state why the patient requires a longer stay. Because our focus is on identifying patients most appropriate for an acute surgical expe- rience lasting less than 24 hours, we do our very best to model those expe- riences beforehand, based on data that predicts an ability to safely discharge a patient with the prescribed time period.” After the discharge, it is important that we intervene quickly, Asher says. “Our data suggests that within the first two weeks after discharge, pain control and medical complications are the main reasons why patients require hospital admission. If we intervene on time, we can prevent that occurrence. Specifi- cally, we optimize our patients’ preop pain control and medical status and we routinely follow up in the first two days postop because those are the intervals that afford us the best opportunities to achieve successful clinical outcomes.” Gollogly says his center experi- mented with CCs but found that the sat- isfaction level was not very high. “Our ASC patients did not want to be co- housed with sicker patients,” he says. Patients do the best at home with


family members, Gollogly contin- ues. “We call the family members to coach and they reinforce the teaching of our staff and the physical therapy (PT) staff. We typically send them home with PT and home nursing ser- vices. How much they use those ser- vices depends on how disabled they were preoperatively.”


Home health agencies send nurses who can help with medical questions, clarification of medicine doses, pain and nausea management, and dressing care, Gollogly says. “However, most patient needs are social, like getting out of bed, getting a glass of water, etc. The social support makes a difference.


If you have a local community that can care for the patients, the surgeries in the outpatient setting will be successful. That trend is reflected across the country. Patients are going home the same day.”


— Sohrab Gollogly, MD, Monterey Spine and Joint and Monterey Peninsula Surgery Center


Someone with a good social support— such as an able-bodied family member who can stay with the patient three to five days after surgery—makes for a good high-acuity patient candidate for an ASC.”


Jablonski’s ASC is partnering suc- cessfully with an SNF and a home care agency. “It is important to find a com- pany that will work with your proto- cols,” she says. “Not every home care agency will do IV medication, like Tor- adol, or have the PT meet the patient at home. So, it takes cooperation.” The insurance piece can be chal- lenging, she adds. “The SNF has to work on getting contracts in place to ensure they receive adequate reim- bursement for higher acuity patients who are discharged from surgery the same day versus the typical patient they see who has had a few days of


hospital recovery,” she explains. “We also have bundled pricing agreements in place where we contract for all the surgical services in addition to SNF and home health care services.” This, however, could take a while, she cau- tions. “We have been using SNFs since 2009, and we waited, sometimes for a year or more, for a contract to be put in place. Some insurance carriers follow Medicare guidelines for three-night hospital stay requirements prior to admission to the SNFs. This requires us to work on a waiver where the insur- ance carrier removes the hospital stay requirement. If we do not receive a waiver, we are unable to accommodate the patient’s surgery at our ASC and need to send that patient to a hospital.” Given current trends in health


care—like value-based payments and price transparency—it is important to


ASC FOCUS FEBRUARY 2018 |www.ascfocus.org 11


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