AS I SEE IT
Supporting More Complex Orthopedics Cases in the ASC Use technology to stay ahead BY THOMAS PINELLI
With advances in surgeon technique and surgical equipment, orthopedics cases once performed in the inpatient setting only
are safely migrating their way to the outpatient setting. ASCs with ortho- pedic programs are increasingly per- forming these more complex cases and for good reasons: Adding such cases can be an effective way to enhance sur- gical volume while also expanding the types of high-quality, lower-cost cases available for their patient community. As their name suggests, however, adding more complex cases can bring with them another level of difficulty concerning clinical, financial and operational needs and demands. Fortu- nately, technology solutions are avail- able to help ASCs effectively migrate, document and receive payment for these cases while improving surgeon, staff and patient experiences.
Clinical Enhancements There are a few qualities often asso- ciated with complex orthopedics pro- cedures. They can be image intensive, use implants or need more instruments and might require prescribing stronger pain relievers. Technology can help an ASC manage all four. To take the images to perform these
cases, ASCs will use devices such as C-arms and ultrasound-guided regional anesthesia. Electronic medical record (EMR) systems often include a picture archiving and communication system (PACS) interface that supports the cap- turing and embedding of such images into clinical documentation. This is essential for preserving the integrity of the documentation. In addition, phy- sicians often want images embedded
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into their operative notes to help com- plete dictation.
An EMR also can help ensure accu- rate documentation of when and why certain types of implants are used during a case. This further supports the accu- rate completion of physician documen- tation and dictation. Electronic capture of implant details meets an important safety need: responding to a recall event. An EMR can help an ASC quickly con- duct a search for which patients received a recalled implant and export these details for streamlined outreach. With the increase in the number of instruments and trays associated with more complex orthopedics cases, inven- tory management takes on even greater significance. An EMR with inventory management functionality can help ensure surgeons always have the instru- ments and implants needed for their cases. If an ASC is missing even a single instrument required for a case, it might need to be rescheduled. If an instrument must be replaced during a case, but an
ASC lacks adequate backup, a case might need to be stopped mid-procedure. Managing postoperative pain asso- ciated with more complex cases often requires the prescribing of potent pain medications. With the opioid epidemic continuing in the US, it is important for surgeons to know if patients have a history of opioid use or abuse. Patients usually are reluctant to share this infor- mation with their doctors. Technology can help. There are solutions available that give real-time medication history information based on prescriptions filled at almost all US pharmacies. This information helps surgeons make more informed decisions when deter- mining a pain management plan.
Financial Support
An appealing aspect of adding complex orthopedics cases is their associated reimbursement, which is often higher than simpler cases. Technology can help secure coverage, better ensure fair reimbursement, collect what is owed
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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