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any odds and ends that may need attention.
Pain control is a huge part of the process. We want to make sure people don't
experience pain prematurely and become overly anxious. To help control pain,
we use COX-2 inhibitors before surgery and during the acute post-op period.
That's one of the important little tricks. It short-
circuits the acute inflammatory pain response. We also use the same multi-
modal approach for every patient, and the surgeon usually starts a pericapsular
block, as well.
It's important to educate patients as to what they should expect in terms of
pain. The blocks we use are very long acting, but we make it clear that they're
going to wear off. Otherwise, patients might get a little anxious when the pain
starts to occur. We also give them some pain medicine (Percocet or something
similar) to take home for when the blocks wear off. We try to avoid giving them
opioids before they go home, because we don't want to see issues with urinary
retention, hypoxia, lethargy or PONV. Above all, patients need to be comfortable
before they're discharged.
Future possibilities
We've found that insurers pay less for total joints in the outpatient setting, even
though we're doing the procedures more efficiently and economically. To make
money on outpatient total joints, it's imperative to control your case costs, espe-
cially for implants. We save the healthcare system approximately $8,500 for each
outpatient total joint we perform, and I think every insurer is going to eventually
want those cost savings. We've been able to get reimbursed for certain cases
that previously weren't payable in the outpatient setting because insurers have
seen the quality of what we're doing. Some say, Really, you can do this? I meet
with payor reps all the time to educate them about exactly what we're doing.
That's been important to the success of our outpatient joint programs and will
continue to be as more programs launch.
