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Archive ORX Session Previews 2019

Build a World-Class Total Joints Program

Darci Nagorski

Darci Nagorski


Same-day total joints continues to be one of surgery's hottest specialties. Patient demand is increasing at an exponential rate, progressive surgeons want to perform the procedures and insurers end up spending less for high-quality care.

"Adding the procedures is a great way to position your facility for the future of outpatient orthopedics," says Darci Nagorski, administrator and CEO of the St. Cloud (Minn.) Surgical Center. Ms. Nagorski and key members of St. Cloud's clinical team will run an informative and interactive workshop at OR Excellence, during which they'll share the insights and expertise they've gained from replacing 1,200 joints since launching their own program nearly 5 years ago.

  • Coordinated care. Ms. Nagorski will discuss the challenges and opportunities of working with an independent group of orthopedic surgeons who bring cases to her multispecialty facility. Making the arrangement work demands clear and effective communication. "We're constantly making sure our goals are aligned," says Ms. Nagorski. "That begins with confirming patients are appropriate candidates to have their joints replaced in our facility."
  • Cutting-edge surgery. St. Cloud's surgeons and anesthesia providers use multimodal pain management, including the latest regional block techniques, to get patients up and moving soon after surgery and ready for same-day discharge. The center also invested in robotic-guided navigation, which differentiates St. Cloud from the competition by helping surgeons perform partial knee replacements, a technically demanding procedure.
  • Managing bundled payments. Insurers are interested in making a single bundled payment to joint programs that take on the risk and reward of managing the entire episode of care, which begins the day surgery is scheduled and ends 90 days after discharge. "More and more insurers are motivated to find ways to reduce healthcare costs," says Ms. Nagorski. "The bundled payment model for outpatient total joints is perfectly aligned with that goal."

She understands how to manage expensive elements of the episode of care by working with vendors to reduce the costs of implants, keeping labor costs low while making sure staff can deliver safe care and partnering with cost-effective rehab providers. Her team will also discuss the importance of optimizing all aspects of the episode of care to avoid the costs associated with treating unplanned complications and to increase profits achieved through excellent outcomes.

"Surgeons want to avoid hospitalizing their patients unnecessarily," says Ms. Nagorski. "The specialty is a good revenue stream that diversifies your orthopedic offerings. It's ultimately an efficient and cost-effective way to meet a growing clinical need in a way that improves the patient experience." OSM

Speaker Profile

  • Spent 16 years overseeing 4 outpatient imaging centers and 3 hospital radiology departments.
  • Has served 2 years as administrator/CEO of the St. Cloud Surgical Center, an 11-room facility performing about 10,000 multispecialty cases a year.
  • Sits on the board of directors of the Minnesota Ambulatory Surgery Center Association.
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