Building blocks
Excelsior's surgeons hold a majority ownership stake in the surgery
center, so they're able to control the coordination and collaboration of
care, which is essential to making the program successful, says Mr.
Uba, who adds, "We manage the protocols, the quality of care, the
patient selection and even the pricing."
Three years ago the practice's surgeons and business staff studied
pioneers in outpatient total joints, knew the physician-owners were
performing joint replacements at the local hospital, looked at their
successful orthopedic surgery center and decided they had the pieces
in place to launch their own program. With a committed team of busi-
ness and clinical leaders, Mr. Uba says you can get a program up and
running in 18 to 24 months, maybe sooner.
Excelsior sank $150,000 to $200,000 into a table that allows a mini-
mally invasive anterior approach to the hip, which helps patients
recover faster. Upgrades to instrument trays, power tools and other
equipment demanded an investment of well over $100,000. Tracking
and measuring case outcomes is a major component of a new joints
program, because the procedures are relatively new and payers want
proof that the surgeries are safe and effective. Excelsior paid about
$30,000 in patient-reported-outcomes tracking software, which col-
lects perioperative and quality data such as rates of complications,
readmissions and infections, as well as pain scores and activities of
daily living.
The investments are substantial but necessary if you're serious about
running a successful outpatient joint program.
Getting paid
You can't run a total joints program if insurers won't pay for it. First
assess the payers in your market to ensure they're ready to reimburse
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