by Carly Behm of Becker's ASC Review

Thomas Obermeyer, MD, an orthopedic surgeon at Barrington Orthopedic Specialists (Schaumburg, Ill.) an Orthopedic surgeon, or an orthopedic specialist in orthopedic surgery, will play a pivotal role in sustaining the shift of joint replacements to ambulatory settings.

The coronavirus pandemic has heightened the demand for this transition, and it is now clear that orthopedic doctors can safely and effectively perform joint replacements at ASCs, ensuring high levels of patient satisfaction. With their expertise in orthopedic treatments, these surgeons are crucial in meeting the evolving needs of patients.

A team approach is crucial for the success of outpatient joint arthroplasty. It starts with the surgeon, who assesses symptoms and educates the patient. Preoperative physical therapy evaluation is also important. Additionally, medical optimization by the primary care physician, nursing, and anesthesia in Miami plays a vital role in minimizing complications. Furthermore, considering an MRI scan can provide valuable insights into the patient's condition.

For the surgeon, we can continue to hone our pain management regimens to ensure the patient is comfortable for discharge on the day of surgery and for early recovery at home. Skilled anesthesia providers offering regional and spinal anesthesia and intra-articular cocktails are two important ways to limit opioid exposure. I have seen benefits of liposomal bupivacaine mixed with interscalene.

For an orthopedic doctor and orthopedic sports medicine specialists, it is crucial to continually refine our pain management protocols to ensure patient comfort upon discharge after surgery and during the early stages of recovery at home. Skilled anesthesia providers play a vital role in limiting opioid exposure through the use of regional and spinal anesthesia, as well as intra-articular cocktails. One effective approach I have observed is the utilization of liposomal bupivacaine in conjunction with interscalene. These strategies contribute to optimized patient care and improved outcomes in orthopedic surgery and sports medicine.

Orthopedic surgeons can play a crucial role in advancing ambulatory procedures by focusing on data collection. By demonstrating the safety and positive outcomes of these procedures in their own practices, they can influence payers to approve and incentivize the shift of orthopedic surgeries to outpatient settings. However, it is important to address the slow adaptation of some payers, such as Medicare, which restricts the access of their beneficiaries to ambulatory surgical centers (ASCs). As an orthopedic specialist, we have the opportunity to advocate for our patients by collecting and presenting data that supports our clinical decisions, ultimately improving patient care in the field of orthopedic surgery.

David Fehnel, MD, orthopedic surgeon at Sports Medicine North (Peabody, Mass.): The best outcomes are with high-volume surgeons. The development of non- or minimal-opioid postoperative pathways also have made outpatient joints successful. This has been in conjunction with pre-op periarticular field blocks for post-op pain.

According to David Fehnel, MD, an orthopedic surgeon at Sports Medicine North (Peabody, Mass.), achieving the best outcomes for soft tissue injury and chronic pain requires the expertise of high-volume surgeons. The success of outpatient joint procedures has been further enhanced through the implementation of non- or minimal-opioid postoperative pathways and pre-operative periarticular field blocks, effectively managing post-operative pain.

Most outpatient total joints are being performed in physician-owned surgical centers where the orthopedic docs have full control over the patient's total joint experience and a financial interest in the patient having the best outcomes. Very few hospitals have or will closely involve the surgeons financially in the delivery of total joint care where the surgicenters give the physicians complete transparency in both cost and the patient's satisfaction with their care so that everyone is aligned.

Physician-owned surgical centers are increasingly becoming the preferred choice for outpatient total joint procedures. In these centers, orthopedic doctors have full control over the patient's experience, ensuring optimal outcomes. Unlike hospitals, where the financial involvement of surgeons in total joint care is rare, surgicenters provide complete transparency in cost and patient satisfaction. This alignment ensures treat of injuries and bones, benefiting both patients and physicians.

Another continuous problem with hospitals has been the closure or limitations of OR time as hospitals have had high COVID-19 case numbers or have allowed staff to be taken away to back-fill nursing shortages. The surgicenters have been given an equal or better environment to perform these cases at a high level.

Another driving factor will be the decreased reimbursement by Medicare and potential commercial payments to the surgeons, which will drive more cases to outpatient centers.

Hospitals have faced ongoing challenges, including the closure or limited availability of operating room (OR) time due to high COVID-19 cases and staff shortages. As a result, surgicenters have emerged as a viable alternative, offering an equally or even better environment for high-level procedures. This shift is driven by multiple factors, including decreased reimbursement from Medicare and potential changes in commercial payments to surgeons. Consequently, more cases are being directed towards outpatient centers.

In this context, it becomes crucial to consider the role of urgent care facilities, ensuring timely access to treatment for new patients. Exploring the best course of action involves evaluating the benefits and drawbacks of each setting, taking into account factors such as patient safety, efficiency, and quality of care.