The move of joint replacement surgery from the inpatient hospital environment to the outpatient setting has become an almost certainty.

Experts like the consultants at Sg2 have been predicting the rise of outpatient joint replacements for many years, and their recent data has been showing an acceleration of the trend, with 2012 to 2015 showing a 47 percent increase in procedures nationally.

In September the agency received comments from both sides of the industry. Hospital groups expressed concerns, as joint replacement surgery usually represents a large profit center within the institution. Surgeon practices and ASC leaders promoted the move.

This month CMS finalized moving knee replacement off the “inpatient only” list so it can be performed on Medicare patients in ambulatory surgery centers (ASCs) in the future. Hospitals that do not have an outpatient surgical setup have been seeking to acquire surgery centers or form joint ventures with them to capitalize on the movement.

Hospital teams will need to learn three new key skills to embrace this trend and prepare to do outpatient joint replacements:

 

Regional Anesthesia Techniques

If your anesthesia teams are not prepared to use the most advanced regional anesthesia approaches for joint replacement surgeries, a program cannot succeed. These new protocols for pain management is what allows patients to get up and move after surgery and go home the same day.

 

Team Coordination

Minimal time with the patient “in house” means all your efforts have to be highly coordinated across the team to maximize efficiency and ensure discharge happens on schedule. There’s no time to be wasted waiting around for medication, equipment or staff resources for education or therapy.

 

Intense Patient Management

Resources to prepare the patient pre-surgery and support the patient post-surgery from home must be in place. Intense pre-op selection, optimization and education can help improve outcomes, while post-op support prevents ER visits and readmissions.

At our past 2018 Interdisciplinary Conference on Orthopedic Value-Based Care attendees participated in a pre-conference bootcamp on outpatient joint replacement led by pioneers from Hoag Orthopedic Institute. The team at Hoag was one of the first in the country to implement an outpatient joint replacement program at their surgery center. At our conference, they shared lessons learned and best practices to get new programs off on the right foot.

 

Our next Interdisciplinary Conference on Orthopedic Value-Based Care will be taking place on January 18-19, 2019 at the Fashion Island Hotel in Newport Beach, CA.