Coming to an ASC near you: total knee replacement surgery
As healthcare costs continue to climb, ambulatory surgery centers are increasingly offering patients cost-effective, sophisticated and convenient outpatient surgical options. Next up for ASCs? Total knee replacement surgery. Starting in 2015, Regent’s Loveland Surgery Center (Colorado) will offer total knee replacement surgery that includes overnight stays at our convalescence center. Just one of the new, innovative patient services Regent is developing, total knee replacement surgery at Loveland will offer patients increased convenience, safer outcomes and lower costs. Loveland also is on the forefront of a gradual national trend away from inpatient care. Decades in the making, the migration of procedures to outpatient facilities is the result of a variety of factors, including regulatory changes, patient preference and clinical advances. According to the American Hospital Association, surgery in the United States during the early 1990s was split roughly equally between inpatient and outpatient facilities; by 2011, outpatient surgery accounted for at least 60 percent of all U.S. procedures. That figure undoubtedly will increase in coming years. One reason for this change is the shifting perceptions of public and private payers, which see an opportunity to increase patient satisfaction, dramatically lower costs and improve outcomes. An example developed by the Ambulatory Surgery Center Association highlights the real cost differences for ASC-based procedures: “When cataract procedures are performed at an ASC, Medicare pays $964. However, if the ASC were acquired by a hospital and converted to an outpatient unit, the payment rate would be $1,671, or $707 more per surgery. If a center performed 2,000 cataract surgeries for Medicare patients (as many do), the government would pay $1.4 million more per year for the ASC’s services if it were converted to an HOPD. In addition, a patient’s 20% co-pay for the surgery would rise from approximately $193 to $490.” For total knee replacement surgery at Loveland, Regent worked closely with local payers to address their concerns. Regent also developed the following process for producing the best outcomes for patients, staff and the facility when total knee replacement surgery is performed:
Patient screening
Outpatient total knee replacement is not for everyone. Certain criteria must be met for a person to be considered as a patient. Screening patients for the following ensures safe and efficient care:
- Good overall health and without risk factors;
- A high level of motivation to participate in rehabilitation and to leave the hospital quickly; and
- A good support system at home, such as family or friends who can help with daily activities and transportation.
Patients with an American Society of Anesthesiologists status of three or higher are typically poor candidates to receive ASC care. Additionally, patients who have experienced major blood loss, morbidly obese patients and individuals who have recently undergone major surgery are not encouraged to have knee replacements at an ASC.
Pre-surgery education
The pre-operation staff is responsible for teaching the patient and family at-home recovery procedures in the days leading up to surgery. Pre-operation classes, which give the patient and family a better understanding of what to expect before, during and after surgery, are required. The pre-surgery class will review education packet information, which includes:
- An overview of total joint replacement
- Pre- and post-surgery information
- Written exercise instructions
- Meeting with the physical therapist
- Nutritional recommendations
- A view of the surgery center and surgical experience
Reevaluating recovery information increases the chance of a favorable surgical outcome.
Operating room staff preparation
Having an experienced and well-trained OR staff is a must with total knee replacement surgery. It’s often useful for the OR staff to get acquainted with instrument trays and joint implants before the center’s first joint replacement operation takes place. Another way for OR staff to prepare is to observe a surgeon perform a total joint replacement operation at a nearby hospital.
At-home recovery
A successful total knee replacement recovery process requires a team effort. Patients return home with the support of an innovative at-home nursing program, which includes in-home physical therapy (PT). In-home nursing and rehabilitation care is provided over the next several days. All post-surgical monitoring that is normally performed in a hospital is performed by a nurse in the patient’s home. A physical therapist visits the patient’s home twice a day for several days to help with range of motion and flexibility exercises. Home PT continues until the patient is medically cleared to travel to an outpatient PT clinic. For more information about Regent’s new ASC total knee replacement programs, please contact Kathleen Bernicky at kbernicky@regentsh.com.
