Presentation Vu Medi SDS 1
2014-12-02
: Pdf Vumedisds 1 VuMediSDS_1 12 2014 pdf
Open the PDF directly: View PDF 
.
Page Count: 6
12/1/2014
1
Same Day Total Joint Arthroplasty Surgery
Overview
WWW.SAMEDAYJOINTS.COM
©2013 Same Day Joints, All rights reserved.
History of Advanced Center for Surgery in Altoona, PA
Establishing a Same Day Joint protocol
−Getting Started
−Aligning Goals across care teams
−Preparing and Implementing protocols
Care Pathway Assessments
−Anesthesiologist
−Home Health Services
Surgery featuring VISIONAIRE and JOURNEY II BCS
−Patient arrival
−Intraoperative care
−Patient discharge
Patient Testimonial
Panel of experts
−CRNA: Dave Berkheimer
−Home Health Care Services: Amy Hancock and Sheena Henry
−Reimbursement expert, CEO UOC and Director of the ACS: Dave Davies
Disclosures
Dr. Kenneth Cherry
-Consultant, Smith & Nephew
Dr. Christopher McClellan
-Consultant, Smith & Nephew
-Consultant, Corentec Inc.
-Consultant, Pacira Pharmaceuticals
Dave Davies, CRNA
-Consultant, Bbraun Medical
-Consultant, Kimberly Clark Pain Management
12/1/2014
2
Advanced Center for Surgery
WWW.SAMEDAYJOINTS.COM
©2013 Same Day Joints, All rights reserved.
First TKA performed December 2012
−126 TJA performed with measured outcomes
−55 THA and 71 TKA
FREESTANDING SURGICAL CENTER
−0.125 Stay –NOT 23hr program
−Home in 3-4 hours from surgery
−Highly advanced protocols
Patient Demographics
−Age 22-72
−BMI less than 50
−68 Female and 58 Male
−ASA Classification 1 and 2 only
−1st Revision
Discharge
−No OTHER option, all d/c straight home
−Requires excellent communication between all providers
−Care Pathway management
This is “accountable care” at its highest level
Understand your Practice and Patient Demographics
–Referral Base
Assess team’s clinical capabilities
–Surgical
–Anesthesia
–PT
Evaluate service line resources
–PT
–Home Nursing
–Home Pharmacy
Negotiate payer contracts in advance
Understand costs and necessary resources
–Facilities
–Instruments
–Staffing
Implement a Joint Coordinator
Identify Team Leaders
Where to start?
WWW.SAMEDAYJOINTS.COM
©2013 Same Day Joints, All rights reserved.
Communication begins with the first office visit
–Patient Education
Cloud Based Care Pathway
–Multi-disciplinary contact
–Direct and Rapid Electronic Communication
Open communication amongst all providers
–Vital to ensure safe and successful joint program
Care is protocol driven
–Changes in patient status, care or condition is communicated to all
providers
–Protocol changes are implemented at Joint Team Board level and
communicated
Communication
WWW.SAMEDAYJOINTS.COM
©2013 Same Day Joints, All rights reserved.
12/1/2014
3
Educate referral base of new improved patient options
Educate office staff and care teams
–Care Pathway and Implementation
–Home Nursing
–Physical Therapy
–Home Pharmacy
Educate surgical team
–Anesthesia Protocol
–Procedure
–Care Pathway Implementation
Train, Practice, Discuss!
–Surgical Run Through
–Equipment/Supplies
–Pharmaceuticals
Data collection
–PI with Care Pathway Process in place
Preparation
WWW.SAMEDAYJOINTS.COM
©2013 Same Day Joints, All rights reserved.
Office Visit
–Patient Complaint- Pain/Arthritis/Avascular Necrosis
–Alternatives to Total Joint Replacement have not aided patient complaints
–Severity of Disease-Requires Surgical Intervention
Patient
–Surgical Candidate
–Motivated
–Wants to avoid inpatient stay
Same Day Joint Replacement Candidate
–Meets selection Criteria
Patient Education
–Identify and understand Home Care Needs
–Patient Responsibilities
Initiate Care Pathway through Joint Coordinator
Implementation
WWW.SAMEDAYJOINTS.COM
©2013 Same Day Joints, All rights reserved.
Patient Arrival
12/1/2014
4
Anesthesia and It’s role in Accelerated Recovery
Healing at Home
Reimbursement –Same Day TJR
Payer Limitations
• Medicare Exclusions “Inpatient Only” procedure; ASC Covered
procedures
•Commercial payers dependent on Medicare coverage policies
Licensing Restrictions
•Approved procedure exclusions of Total Joint Codes
Participating Payers
•Highmark Blue Cross/Blue Shield
ACS Facility Reimbursement
•Negotiated Fee for Service (Procedure Based) plus Cost carve
outs for Implants
Physician Reimbursement
•Incentive Based Fee for Service (Procedure based payment
increases based on Episode Quality and Cost Performance)
Under Development
•Retail Bundled Pricing
12/1/2014
5
Cost Per Episode
•ASC v. Hospital
–Clinical advancements and cost efficient protocols are generally portable
and can be applied in a hospital based setting.
–Hospitals conceptually recognize the need to adapt and share with
consumers lower unit costs
–Convincing Hospitals to pass cost savings to the consumer in terms of lower
pricing or out of pocket expenses remains a challenge
•Health Insurers recognize that narrow networks improve
cost and quality performance predictability
•Desirable networks include physicians who practice
evidence based medicine AND utilize cost effective
facilities
•The gateway to earning payment incentives for
physicians is quality, and the means for insurance
companies to fund the incentives is lower facility cost.
•Physicians practicing quality medicine in high cost
venues will end up in those network tiers that will require
the patient to pay an increased cost to access them
•Today, low costs and high value trump provider choice
Partnering with Payers
“It’s like bringing Moneyball to health care”- Brett Morris, President of Health Net of Arizona
VISIONAIRE & JOURNEY II Overview
