SwiftPath: Witnessed and demonstrated — The outpatient joint replacement


With more than 8 million Americans currently living with severe arthritis and with half of all joint replacements today performed on patients under the age of 65, it is clear that the need for joint replacement will continue to increase. This coupled with the increasing costs of joint replacement care is demanding that surgeons and other stakeholders work together to develop new solutions; solutions that improve care, improve the patient experience, and reduce cost.


“Outpatient joint replacement methods and transitioning these surgeries to ambulatory settings offers one of the most powerful, rewarding, and effective solutions—for patients and doctors alike,” says Craig McAllister, MD, President and Chief Medical Officer of The SwiftPath Program.


On March 4, 2016 in Orlando, Florida SwiftPath joined with Pacira and Aesculap to sponsor a symposium where a collection of distinguished experts addressed the "The Best Practices in Outpatient Joint Replacement." Marshall Steele, MD, is recognized for his pioneering work in developing joint replacement centers of excellence, focusing on clinical pathways, specialized teams, the role of patient education, and alternatives to narcotic pain medications. Dr. Steele served as the keynote speaker and commented that “not that long ago, it was normal for patients to be in the hospital for seven to 10 days after routine hip and knee replacement.”


He helped introduce joint camps where patients were given the opportunity to be involved in their own care. "If patient engagement were a drug, it would be front page news, and malpractice for doctors not to use it,” he says.


As he focused now on outpatient joint replacement, he talked about future challenges and opportunities. "When you think about outpatient joint replacement, you can see that the traditional model of care and actually the one that I designed 20 years ago is really going by the wayside… and what we need now is a really comprehensive program that can truly be called excellent. That's really where SwiftPath comes in," says Dr. Steele. SwiftPath aims to help more orthopedic surgeons take their cases outpatient during a roundtable and bioskills lab event at MemorialCare Outpatient Surgical Center in Long Beach, Calif., on Feb. 24, 2017. The event is titled "SwiftPath: Launching the Triple Aim."


"The SwiftPath vision has never really been centered exclusively on outpatient joint replacement. On the contrary, our mission is to advance surgical methods and patient engagement around making the move from two to three days in the hospital to 23 hour stays," says Dr. McAllister. "SwiftPath allows appropriate patients to be shifted to the more cost effective ambulatory space so that the intensive resources of our hospitals can be devoted to the patients who need them the most."

Dr. Steele credited SwiftPath's RoundTable meetings and use of the Delphi Method that have been used over the last 10 years to develop a methodology focusing on responsible innovation. Modern pain management, objective and measurable patient selection methods coupled with predictive analytics, minimally invasive surgical techniques, patient education and cloud-based home care monitoring. "I think these issues are critical…Getting the patient to the right surgeon and the right place is really going to be important," he says.


According to Dr. McAllister, the adoption of outpatient methods is increasing but is dependent on regional variations, patient demographics and market forces. Still, the increasing number of patients with high deductibles and legitimate fears of surprise medical billing is opening the door for the shift to the outpatient setting. "High quality outcomes, shorter lengths of stays and ultimately lower costs make the outpatient settings attractive to payers, providers and patients alike."

Doug Vermillion, MD, heads the Orthopedic Research Clinic of Alaska and specializes in hip and knee replacement. "SwiftPath is a revolutionary new method that combines patient education, cutting edge surgical techniques, and the latest research in communication and surgical recovery," says Dr. Vermillion.


He points out that most of the complications related to joint replacement are related to pain and the use of outdated methods. "These are eliminated with the SwiftPath technique. When we talked to the contractors we showed them some of our patients and the process and they liked the idea of their patients having less of the complications, a better value and less cost because there's less complications and a much better process to go through. It's very reproducible and in our hands it's been working well for us so far."

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