S
houlder replacements were already
moving strongly in the direction of out-
patient facilities before the pandemic
hit. Within the outpatient world, I've
seen a steady move to freestanding
centers as opposed to hospital-based outpatient
departments (HOPDs). Now the pandemic is hasten-
ing these shifts even more, as we try to keep patients
away from hospitals that treat COVID-19 patients.
I've done some elements of outpatient shoulder
surgery since my career began in 2002, and we've
come a long way. In the nearly two decades since,
I've become much more comfortable performing
shoulder surgeries inside ASCs, to the point where I
now perform the vast majority of them at our cen-
ters. I'm quite confident at this point that almost all
the procedures I perform as a shoulder surgeon can
be done in an ambulatory setting — provided the
patients are medically appropriate.
If you're running a surgery center that performs
shoulder surgeries, or thinking of opening one, let
me share some clinical and business ideas that have
been successful for us:
• Patient selection. You need to figure out which
patients are most appropriate for your facility. We
maintain strict exclusion criteria for our shoulder
patients, with a particular focus on BMI and other
significant comorbidities. For instance, a BMI of 40
2 2 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 2 0
BOLD SHOULDER Gregory Lervick, MD (left), feels comfortable performing all of his shoulder replacements in an ambulatory setting because of the specialization and consistency of
staff and equipment.
Gregory N. Lervick, MD | Minneapolis
Tips for Taking On Total Shoulders
Focus on these important factors to capitalize on a promising specialty.
Ryan
Shaver
