Elective Total Hip and Knee Replacement Surgery Campus

Trinity Bettendorf*

Mississippi Valley Surgery Center

Total % Outpatient

2013 463 115 578


2014 475 126 601


2015 459 165 624


2016 517 248 765


2017 654 320 974


5-Year % Increase


178% 69%

*DRG 470, elective cases only. Source: Sg2 Interview With Mississippi Valley Surgery Center and Trinity Bettendorf, 2018.

Outpatient growth, however, will soar—57 percent of all nonfracture knee and hip replacements will be performed in the OP setting by 2028.”

—Amanda Olderog, Sg2

The ability to thrive during the tran- sition to outpatient total joint replace- ment surgery requires an expansion of the System of Clinical Alignment and Resource Effectiveness (CARE) per- spective. The new comprehensive TJR program now includes outpatient ser- vices in the hospital and ASC settings. Organizations able to define and deliver on the value proposition for key stake- holders will be strategically positioned for growth in all the right places.

Case Study

UnityPoint Health—Trinity operates four full-service hospitals in Illinois and Iowa and performs more than 1,000 hos- pital-based inpatient and outpatient joint replacement procedures annually. Addi- tionally, Trinity has performed more than 2,500 outpatient total joint replacement surgeries since the program’s incep- tion at Trinity’s Mississippi Valley Sur- gery Center (MVSC), in a joint venture with community physicians and Surgical Care Affiliates. The forecasted growth of TJR surgery, along with the removal of total knee replacement from the CMS inpatient-only list in 2018, triggered an expansion of MVSC that nearly doubled overnight bed capacity. The expansion

12 ASC FOCUS MAY 2019 |

was supported by hospital leaders who serve on the ASC board and partner with surgeons on growth and patient expe- rience strategies for both the ASC and hospital care sites.

Physician-Driven Transformation The outpatient joint replacement move- ment at Trinity started as an initiative of a single high-volume joint replacement sur- geon more than 10 years ago. Today, 85 percent of patients are discharged directly home the day after surgery at Trinity’s Bettendorf, Iowa, hospital campus and a significant proportion of commercial TJR patient procedures are already per- formed in the ASC joint venture setting.

Focusing on Patient Experience Across Sites of Care The patient experience heavily focuses on RN navigation, patient engagement in the healing process, and quality and patient experience improvement in both the hospital and ASC sites of care. ■■


eling from a distance, Trinity’s Rapid Recovery Joint Replacement Guide is available online as a supplement for those attending the preoperative patient education course known as Joint Academy. Education continues post-discharge and focuses on iden- tifying and resolving common issues that might lead to emergency depart- ment visits or readmission. The RN navigator also serves as the consistent voice of the program to the care team on protocols and expectations. ■■ Engagement and support:


geons kick off patient engagement expectations in the office setting, heavily reinforcing the need for the patient to identify a “coach” to be present throughout the education and recovery process.

Quality and patient experience improvement: Surgeons partner with hospital and ASC leadership on con- tinued refinement and measurement of key outcomes, including quality and patient experience. Program ini- tiatives include site of care selection criteria, patient optimization for sur- gery and perioperative and postopera- tive protocol development.

Outcomes: Year-over-year ASC and hospital growth demonstrated Mississippi Valley Surgery Center’s early entry into the outpatient


Navigation and education: A pil- lar of the program, the RN navigator serves as the point person for patient and care team education, rounding and post-acute follow-up. Because the program includes many patients trav-

replacement surgery space allowed for program differentiation among patients and payers. As one of the first ASCs in Iowa to partner with commercial pay- ers, MVSC’s combined hospital and ASC programs witnessed incremen- tal growth in joint replacement sur- gery volume. Most notably, growth in the surgery center did not result in hos- pital inpatient volume declines. This is consistent with Sg2’s message that TJR surgery growth will require capacity evaluation across all sites of care.

Amanda Olderog is a senior director at Sg2 in Skokie, Illinois. Write her at

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