01.21.19

Moving onto the next 100 TJRs: How this Ohio ASC’s TJR program continues to evolve

Written by Mary Rechtoris | March 29, 2017 Since performing its first partial knee replacement in February 2015, Youngstown, Ohio-based The Orthopaedic Surgery Center has fine-tuned and built upon its TJR program. The surgery center has performed more than 100  joint replacement procedures and plans to increase access to more low-cost, high-quality musculoskeletal procedures in the near future to its customers. Taylor Cera, the ASC’s administrator, says the center is the first ASC in the state accredited as an ASC arthroplasty center by Ohio Bureau of Worker’s Compensation. “We’ve been on the forefront of the current evolution in healthcare, raising the awareness of cost and quality to our patients – enhancing the overall patient experience,” Mr. Cera adds.

Preparing for its TJR program

The 18-month preparation process for the TJR program was quite extensive, notes Thomas Joseph, MD, an orthopedic surgeon who has been at the center since its inception in 2003. Dr. Joseph and Mr. Cera traveled across the country to learn what a successful TJR program entailed and how they could implement these components into their center’s program. The preparation process featured key steps including: •    Developing care pathways and protocols •    Educating the perioperative clinical team •    Analyzing equipment needs, such as instrumentation and implants custom to their joint surgeon’s preferences •    Building relationships with payers to successfully provide these new services while maintaining financial viability and providing optimal patient care. The ASC did face some initial challenges in effectively negotiating with payers due to the minimal data it had accrued at that point. “It took a lot of work for both parties to understand where the other party was coming from and how we could work together to provide the best care to the customer” Dr. Joseph says. “Once the payers realized the ground work has been done and was being done in other parts of the country and we wanted to follow suit, they came on board.” The ASC employed an approach that simplified the process by first looking at cost. The Orthopaedic Surgery Center showed payers the potential cost savings they could obtain from working with the ASC as opposed to larger health systems in terms of the variation in costs for the joint replacement and post-operative rehab. “We operate more efficiently — there’s less operational expense and there’s less waste,” Mr. Cera says. “We were transparent with our potential cost data of a joint replacement case with the payers.” After assessing the cost data, the ASC looked at its quality scores. Dr. Joseph notes this data showed the center could “provide access to high-quality, low-cost joint replacement care,” with the surgery center currently boasting a less than 1 percent infection rate each year. As the ASC performed more procedures and the staff became well acquainted with the program’s protocols, the center created an environment of trust, continuity and consistency. “It was amazing to see the maturity of the program and the reactions from different stakeholders in the community, says Mr Cera. “You could see the evolution of the surgeon’s trust and comfort with the program.” The ASC employed both a patient- and physician-centered approach in which the providers are the key decision makers for the patient’s care. The surgical team is the same every day, with Mr. Cera noting the surgeon sees each patient between four to five times each day at the center. “Every team member is brought into the success of the patient,” he says. “It’s personalized patient care.” Since 2015, the center has boosted its pre-op education for patients, launched a joint education class and has gathered cost and clinical data.

Pain management & patient education

Outpatient total joints would not be feasible without a thorough pain management protocol in place. Advancements in protocols and techniques have facilitated the push for these procedures into the outpatient arena. Dr. Joseph says staff members address a patient’s pain at multiple levels through a regional block, utilization of numerous medications and using various anti- inflammatory medications, steroids and narcotic agents. Teamwork between the surgeon and anesthesiologist is integral to managing a patient’s pain. “In the ASC setting, there is outstanding collaboration between the surgeon and anesthesiologist to provide the best possible multimodal analgesia,” Dr. Joseph says. Bringing the patient into the fold is also essential, as an educated and motivated patient will obtain most benefit from this accelerated recovery approach. The ASC’s post-operative protocols allow them to be “up and moving after surgery,” Dr. Joseph says. To ensure patients are fully aware of what to expect during and after surgery, they attend the ASC’s total joint class where they learn all the components — from what to expect the day before surgery, the day of surgery and physical therapy following discharge. “Our registered nurses walk the patient through the whole process,” Mr. Cera says. “The results have been extremely positive with high attendance and patients being interactive with our instructors.  Patients have become more aware of their surgical care for various reasons and the class allows them to become even more informed and educated. Healthcare’s future remains by in large, fairly uncertain. While medical professionals and patients alike await legislation that could dictate the course of care, one trend will likely remain unchanged — the ability to maximize efficiency. This push will bode well for surgery centers that have consistently shown they can yield optimal patient outcomes. ASCs will likely continue to push the envelope and tackle higher acuity cases, including The Orthopaedic Surgery Center. Dr. Joseph notes the center’s future plans include boosting its services and providing additional fracture and minimally invasive spine care to patients. “Independent ASCs have the ability to make change and react to the industry,” Mr. Cera says. “Our success over these last two years in our TJR program and other initiatives is due to our autonomy and clinical and business teams reacting to change, making decisions and implementing change. We want to be able to provide access and information for a musculoskeletal network where the patient can receive pre-operative imaging, surgery and post-operative rehabilitative care in the most efficient low-cost, high-quality settings.”