Accommodating Complex Ortho Cases

Focus on fundamentals and communicate BY ROBERT KURTZ


otal hip. Total knee. Partial knee. Total

shoulder. Lumbar fusion.

Lumbar laminectomy. Cervical disc replacement. Anterior cervical discec- tomy and fusion. Extreme lateral inter- body fusion.

These are just some of the complex orthopedic cases making their way out of hospitals and into ASCs. Surgeons like James Ballard, MD, who special- izes in adult joint reconstruction and is a partner at the Oregon Surgical Insti- tute (OSI) in Beaverton, Oregon, are embracing the migration.

“Performing these procedures in

the ASC benefits surgeons, patients and commercial payers,” Ballard says. “For surgeons, we can implement technologies and best practices in a much nimbler fashion. We also hand- pick the anesthesia providers, who work closely with us on innovation, technique and complications. Patients can avoid the hospital, which is more

14 ASC FOCUS MAY 2019 |

appropriate for sick people, and typi- cally receive safer, better care. Payers save money and their members still receive outstanding quality.” For surgery centers that properly accommodate these cases, there are numerous benefits, says Stephanie Leventis, RN, executive vice presi- dent of development for Nevada-based SurgCenter Development. “If you already have orthopedic sur- geons performing more routine cases, you can offer them an extra level of con- venience by taking on their more com- plex cases,” Leventis says. “Instead of giving surgeons a half day in your oper- ating room, you may now be able to allocate a full day, eliminating the need for surgeons to travel between facili- ties.” In addition, your ASC will provide an additional service to its community, and if you are in a more rural area, you may be the first to offer some of these

cases on an outpatient basis, she adds. “That is a great marketing message.”

Overcoming Challenges

One of the most significant obstacles ASCs might need to overcome to start performing complex orthopedic cases is simply getting started, Ballard says. “A big challenge to moving these cases out of the hospital is inertia. There are longstanding norms concerning what is needed to perform these cases: Keep- ing patients in a hospital for a week, putting catheters in their bladders, not allowing them to walk on the day of their surgery. These may have been established practices and paradigms in the past, but that does not make them the right practices today.” Getting everyone who needs to be on board with moving these cases to the ASC can prove difficult if someone does not embrace the idea that there is a way for people to feel better sooner, get home sooner and have a holisti- cally better experience with their sur- gery, Ballard adds.

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