Outpatient Network News: Volume 29, Number 3

“Steve Lucey, MD, of Delta Joint Management in Greensboro, NC. Dr. Lucey and his colleagues worked to align payers, the ASC, and surgeons to create a value-based outpatient joint replacement program. The Surgical center of Greensboro has performed 200 cases and saved insurers over one million dollars. Dr. Lucey emphasizes that the key to success was developing a prospective bundle, with surgeons controlling it and taking the risk. Dr. Lucey explains that 100% of clinical decisions are financial decisions, and surgeons can impact vocalizer better than others.

Arthroplasty surgeons in the ASC include sports medicine and general orthopedic surgeons who perform 75-150 total knees per year. In order to achieve scale, a successful outpatient joint program must also draw high volume arthroplasty surgeons, who don’t necessarily have an incentive to leave the hospital and work in an ASC. Involving them in the design of safe, high quality patient care, excellent patient experience, and aligned financial incentives creates the formula to attract surgeons. 

In summary, there has been a great deal of debate, projections, technologies, and what-if scenario generation on the shift of orthopedics and other specialties to an outpatient setting. In our short review of the landscape, it is apparent that economics, more than clinical issues, is driving the shift. Providers have become much more savvy about performing the surgery in a setting that both reduces costs and maximizes margin. If an “inpatient” knee replacement will generate $12,000, and an “outpatient” knee will generate $9,000 from Medicare, there will be little incentive for a hospital to move the cases from a higher-paid setting to a lower one. However, as insurers, including Medicare authorize or even require ambulatory surgery settings, the incentives will become more obvious.”