with Cigna and United Health Care.
Getting started with total joints
The financial aspect was only one half of embarking on our outpatient
total joint journey. Once we had figured out the bundles and signed on
to partner with one private payer, we needed to focus on getting our
center physically ready to execute total joints. When looking to imple-
ment total joints, we first had to decide what we wanted to offer. We
landed on "everything" — total knee, total hip and total shoulder.
Then we had to assess our center and see what tools or devices
would better help us execute total joints. For us that meant buying a
Hana Bed, worth about $100,000, in order to do anterior hips. The bed
helps you rotate the patient's leg, hyperextend it and support it during
total hip surgery. It was a costly purchase but one that would be an
investment and would make our center more appealing to patients
and surgeons.
As you look at investing in devices, you also need to streamline the
process. For example, in a total joint procedure in a hospital, a rep
might bring 6 trays of instruments. That's not feasible in an outpatient
setting, so ask the rep to bring fewer trays.
The final step for implementing outpatient total joints is forming a
routine for the period of care. When a patient first comes to our facili-
ty looking for a total joint replacement, a case manager goes through
a 17-question quiz with them checking for a high BMI, a history of
smoking, diabetes and heart disease. All of these can be a reason to
reject their request for an outpatient surgery. It's important that you
remain highly selective early on in the process in order to make the
transition easier on your staff and surgeons.
Much of the surgery itself is similar to the surgery in an outpatient
setting, but your post-op routine will be different. In our center, the
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