Access Now: AORN COVID-19 Clinical Support

Archive ORX Session Previews 2020

Set Up for Success in Outpatient Total Joints

Position your facility to capitalize on one of same-day surgery's hottest specialties.

Total joint replacements continue to be one of outpatient surgery’s hottest specialties. Positioning your facility to capture increasing case volumes demands developing an evidence-based clinical pathway, properly managing the entire episode of care, effective pain management and proper patient selection. During what’s sure to be a highly attended workshop, Greg DeConciliis, PA-C, CASC, administrator at Boston Out-Patient Surgical Suites in Waltham, Mass., and Colbie Fredette, RN, the facility’s nurse manager, will discuss launching the first total joints program in Massachusetts, share how COVID-19 has impacted patient care and their top strategies for negotiating with insurers and vendors.

What are the keys to developing a total joints clinical pathway?
It requires convening all stakeholders for lengthy discussions about its essential elements. All aspects of an episode of care should be addressed, including how to optimize patients for surgery and ensure successful recoveries and outcomes. It’s also beneficial to network with other facilities that have already begun same-day joints to learn about common pitfalls and pillars of success.

What’s the best way to manage the entire episode of care?
With people generally plugged into technology, it makes a ton of sense to harness this captive audience to your benefit. Communication apps ensure patients comply with pre-op care plans and follow post-op directives during recovery, which helps them acheive optimal outcomes. In addition, most of the apps capture outcomes data, which is crucial to measuring the success of your program and is sometimes needed to secure payments from insurers.

Greg DeConciliis,PA-C, CASCO
Greg DeConciliis, PA-C, CASC
  • President of the Massachusetts Association of Ambulatory Surgery Centers and is a physician assistant in orthopedics
Colbie Fredette, RN
  • Has more than 30 years of experience in nursing and healthcare management, and is the nurse navigator of the total joints program at Out-Patient Surgical Suites

Why is patient selection so important?
It’s the crucial first step for every case. Our multidisciplinary team outlined patient selection criteria, and we made a commitment to not deviate from them. Patients who are motivated to be discharged on the day of surgery and fully understand recovery protocols are typically good candidates. In addition, it’s important to consider the support system patients must have to achieve successful outcomes. These are all important factors to consider that sometimes get overlooked.

What are your top strategies for negotiating with insurers and vendors?
The first step is clearly outlining the goals of the program and how you’re going to run it. Making insurers understand that the shift of site of service will be a win for them as well will aid in your negotiations. You have to meet with an insurer’s medical team to outline the clinical pathway and make them understand that all aspects of care will be closely managed, the surgeons who perform procedures have proven track records of success and your facility can deliver care at a substantially lower cost. Making vendors true partners is the best strategy. Purchasing supplies and equipment from a single source and standardizing as much as possible to create a volume shift for a vendor will ensure the best success in negotiations.

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