Performing TJR in the ASC Setting Careful planning, patient selection and billing are key BY NADER SAMII

“You have to change your thinking if you desire to have a future different from your present.” —Germany Kent, print and televi- sion journalist, author, actor

Not long ago, when a patient needed total joint replacement (TJR) surgery, a long hospital stay was a given. Common thinking

has changed, though, as more patients now are undergoing TJR procedures in the ASC setting. Indeed, while TJR surgeries in ASCs were not an option just a few years ago, they are, in many instances, starting to be a preferred choice. In an ASC, patients typically benefit from a more intimate and personalized overall surgery experi- ence, can recover in the comfort of their own home and have a decreased risk of infection. Surgeons also enjoy the effi- ciency, focus and scheduling flexibility of an ASC. Importantly, moving these complex and expensive surgeries from the hospital environment to an ASC presents a rare opportunity to have a financial win-win-win for patients, phy- sicians and payers as it provides a lower cost option for patients, financial ben- efits for physician shareholders due to their ASC ownership, and significant cost savings for payers. Of course, performing TJR surger-

ies in an ASC requires surgeons and nurses to think differently about how they do their jobs. First, selecting the right candidates for TJR surgeries in an ASC is key. The ASC setting is a viable, and often preferable, option for middle aged, non-obese patients who do not suffer other significant medical condi- tions and who have strong at-home sup- port systems in place. Patients with con-

20 ASC FOCUS MAY 2019 |

traindications, such as body mass index (BMI) greater than 35, chronic obstruc- tive pulmonary disorder, diabetes, high risk or history of deep vein thrombosis/ pulmonary embolism and many other conditions, are typically not viable can- didates for an ASC.

Once the correct patients have been identified and scheduled for surgery in an ASC, it is critical that the other team members—front desk staff, bill- ing personnel, managed care analysts

and coders—also build a process that is focused on properly handing the business of total joints in an ASC.

Reimbursement for TJR When it comes to TJR procedures, the financial stakes are quite high. While reimbursement for TJRs varies widely based on geographic region, specific payers, competition in the local mar- ket, and the background and skillset of the particular surgeons and ASCs under

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.

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