Outpatient joint replacement and the pitfalls of 'Doing it Yourself'


Value-based systems, bundled payment models, and the need to improve the patient experience are fueling in increasing interest in outpatient hip and knee replacement.  “Healthcare, and the escalating cost of healthcare, has become one of the most critical national and political issues of our day. And “site of care” has been identified as one of the major drivers behind this cost escalation. As such, many analysts are predicting that one of the critical ways to begin bending the cost curve is addressing the “site of care” and surgical procedures to lower cost settings, including shifting joint replacements to the outpatient environment, says Goran Dragolovic, Senior Vice President for Surgical Care Affiliates.

Dr. Craig McAllister is the Chief Medical Officer of The SwiftPath Program. SwiftPath recently held a symposium focusing on proven methods in outpatient joint replacement and the challenges faced by surgeons transitioning to the outpatient space. According to Dr. Craig McAllister, “our data shows that less than 1% of hip and knee replacements from 2011 to 2014 were done as outpatients. That number stands in stark contrast to the 50% that analysts, hospital executives, payers, and CMS are expecting in the next 5 – 10 years.”
“I personally think that the idea of transitioning that many joints to outpatient surgery raises some eyebrows,” said Dr. David Galluch. The SwiftPath Program was recently launched at Ohio Valley Surgical Hospital where Dr. Galluch practices. According to Dr. Galluch, “there are critical steps that must be taken prudently. If there's going to be a change like this that is going to have different drivers, both patient factor drivers, economic driving factors, you have to make sure that the patient care factors don't get left in the back seat. That's why we have implemented SwiftPath.”


To prepare for the future of joint replacement, most facilities and surgeons are trying to develop better patient education, outcomes measures, and non-narcotic pain management platforms. “But what we see across the country is variable and incomplete,” said Dr. McAllister. He pointed out that trying to do this as individual surgeons and departments is overwhelming. “Educating surgeons on minimally invasive surgical techniques and developing clinical pathway guides are hard enough. But then trying to deal with the regulatory and compliance issues, the cost of developing cloud platforms, and the rapidly changing landscape simply make these grass roots efforts difficult to finish and even harder to sustain.”


Traditional hospital-based joint camps will need to be re-invented as patients begin to realize that hospitalization is simply no longer necessary. Pathway selection algorithms will need to be incorporated so that hospitals’ intensive resources can be focused only on those who actually need them. Interactive online educational platforms that hold patients accountable for education, communication, and management of their care will empower patients like never before. Surgeons will need to adopt new learning behaviors as well. We are going to need to find ways to stay on top of trends that are moving much faster. “That kind of a paradigm shift does not come in a vacuum. It requires revisiting most of those assumptions made by clinicians and the surgeons. Nobody is better suited and better qualified to lead that charge than the surgeons themselves. To lead that charge, the physicians will have to revisit a whole litany of decisions that they are making and how to view the patient preoperatively, how they are managing the patient intra-operatively, and then how they are monitoring and engaging the patient postoperatively—Goran Dragolovic.


“Unless we are comfortable that you have been properly trained and are using proven clinical pathways, it doesn’t matter how much money is saved if outcomes suffer.  The beauty of SwiftPath is that it produces superior clinical results.  Rather than having physicians sort this out on their own, which is a lot riskier, it's better to include them to the Round Table where they can get up to the learning curve much faster and they don't have to reinvent the wheel that is actually iteratively being created by a large group of clinicians.” Goran Dragolovic

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