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“Everyone” includes commercial


payers. As Leah Ethridge, owner and president of Surgical Management Asso- ciates in Biloxi, Mississippi, has wit- nessed, convincing payers to provide cov- erage for complex cases is not assured. “A major payer in Mississippi has a rule that it will only cover total joints performed in single-specialty orthope- dic ASCs,” Ethridge says. “We have been asking this payer to expand its coverage since 2016. We are engaged in ongoing discussions but still wait- ing. While local networks have been more responsive to covering complex cases, we struggle to advocate a won- derful product from a niche market to giant corporations that often make decisions based on algorithms, statis- tics and accounting principles.”


Moving Forward


Unless you plan to accept only self-pay patients, securing fair managed care contracts should be one of the first steps your ASC completes, Leventis says. “From a financial perspective, add- ing complex cases can provide a finan- cial benefit for the center. Make sure to review all managed care contracts to ensure the appropriate coverage.” Adding these cases can be excit-


ing, and physicians may be eager to get them scheduled at your ASC, Leventis says. Do not let that enthusiasm cause you to overlook completing other fun- damental steps. “Make sure the physi- cians who want to perform these proce- dures are credentialed for and qualified to perform them and plan to bring enough case volume to justify adding them,” she says. “To perform complex procedures, you need the appropriate equipment—e.g., beds, tables, position- ing devices, instrumentation, implants.” Communication from when you


start moving ahead with adding a case through the first procedure is essential to success, Ethridge says. “Everyone should understand how their role and the entire process will ensure a seam- less patient experience. Strong rela-


petitors. When patients do not come to me, there is a good chance they will go to one of our other surgeons. And yet we all sat down, agreed to bring our ideas together and came up with single pathways for how we would perform total hips and total knees.” Following a single pathway provides


A big challenge to moving these cases out of the hospital is inertia.”


— James Ballard, MD Oregon Surgical Institute


tionships between the ASC and its sur- geons’ office staff and management are paramount.”


The importance of communica-


tion extends to patients, Ethridge adds. “We have a preop nurse who calls each patient and spends as much time as nec- essary answering questions and assur- ing that the patient is well-prepared for the surgery and follow-up care.” Ballard says close collaboration between surgeons and anesthesia is crucial. “Your anesthesia providers on these cases must be forward-thinking and possess outstanding skills. Anes- thesia and surgery are the two main elements of an operation, so they must be on the same page.” If your ASC has multiple surgeons interested in performing these cases, they also must be able to work together, Ballard says. That might be easier said than done. “We have three of the highest volume total joint surgeons in Oregon in our ASC. We are all technically com-


many benefits when performing com- plex orthopedic cases, Ballard says. “It has been proven in medicine that stan- dardization and streamlining processes leads to higher success and lower com- plications. At OSI, every surgery is per- formed exactly the same way down to every detail you can contemplate, from the number of pills patients receive to the type of anesthesia provided to the schedule for therapy. Our staff always know exactly what we will do and what needs to be done.” Make sure the clinical personnel


assigned to these cases have the skills necessary to support them, Leventis says. “When surgeons are comfortable with and confident in their staff, they will be more inclined to bring these complex cases.”


Do Not Reinvent the Wheel The good news for ASCs consider- ing adding complex orthopedic cases, Ethridge says, is that these facilities can learn from the experience of oth- ers. “Speak with peers in the industry who run centers with experience in the services you are considering. You may also want to attend educational ses- sions. I learned a great deal about total joints from an ASC that has been per- forming them for many years during sessions at the ASCA annual meeting. The information presented and experi- ence shared was invaluable.” Ballard said he took the time to visit


an ASC in Ohio performing total joints before OSI launched its program. “Based on what I saw and learned, I came back with a clear vision of what we needed. This greatly helped us cre- ate the foundation for what eventually became the program we have today.”


ASC FOCUS MAY 2019 | ascfocus.org 15


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