ASC management: Scaling down for cost and labor efficiencies

In 2019, more than 1.2 million hip and knee replacement surgeries were performed in the United States—a number that continues to rise and is expected to steadily grow over the next decade.

In that same year, research by UnitedHealth Group that looked into the safety and cost savings associated with ambulatory surgery centers (ASCs) found that if half of routine hip and knee replacements performed in hospitals on an inpatient basis were moved to ASCs:¹

• More than 500,000 surgery patients each year would avoid staying overnight in a hospital.
• $3 billion would be saved annually.

ASCs with established joint replacement programs, the research concluded, are operating safe, scalable models that achieve high-quality results for knee and hip replacement surgeries by relying on specialization, repetition, scale and other key elements, including:

• Care pathways specific to joint replacement patients to help ensure each component of the surgical intervention—including preoperative preparation and post-discharge planning—is optimally defined, sequenced and executed.
• Physicians operating with teams consisting of their preferred surgical technicians and nurses.
• Operating rooms customized for surgeons and their teams.

It’s an outpatient model that Surgical Investors & Advisors (SIA), a leader in hospital-physician joint ventures based in Alpharetta, GA, and Medline are evolving into best practice. Together, they are creating total joint centers of excellence that are able to produce higher quality outcomes for more patients without the financial and operational constraints associated with large multi-specialty outpatient facilities.

“If you look back at how hospitals moved into the ASC space, there was the tendency to recreate the hospital environment in a freestanding setting,” explains Robert Wildmon, Vice President of Operations for SIA. “These were large facilities with too many specialties, causing ORs to be underutilized creating a complex supply chain.”

SIA saw the potential to lower costs and increase quality by converting 4-OR multi-specialty facilities into 2-OR total joint only centers of excellence that are capable of handling as many as 250 cases a month by utilizing space wisely, operating efficiently and maximizing capability. “We now have the capacity to efficiently manage a substantial case load within a 2-OR facility, all while maintaining high-quality patient care,” says Lacey Dyer, Vice President of Clinical Operations for SIA.

If half of routine hip and knee replacements performed in hospitals on an inpatient basis were moved to ASCs:

The first total joint only ASC opened by SIA in Metro Atlanta is now serving as a plug-and-play model for other facilities the company is looking to open across the southeastern United States and, eventually, nationwide.

The center grew out of a joint venture between a local hospital and a group of surgeons who were developing protocols for same-day discharge of patients after primary total joint replacement. Designed as part of a medical office building on the hospital’s campus, the center originally called for four ORs, but after a deep dive into associated costs, the plan was finalized for two ORs and 10 care unit bays.

SIA turned to long-time medical manufacturer, distributor and supply chain partner Medline to help identify and standardize the surgical kits and supplies that would be needed for the new model. Working with anesthesia specialists, OR technicians and circulating nurses, Medline developed a preoperative kit and custom pack modules that would maximize utilization and reduce waste.

• PACU length of stay: Reduced from 141 minutes to 109 minutes in four years
• On-time starts: 100% in first three years
• Turnover time: Reduced from 11 minutes to 9 minutes in 2023
• Max cases per day: 21 cases, with 4 p.m. off-table time for last case
• Patient satisfaction: 95%

SIA has since opened a sister center and expects to finalize two more this year. A priority in operationalizing its growth strategy nationwide was making sure that the supply chain could support the kind of total joint center of excellence SIA envisioned.

In scaling the model, SIA relies on Medline as its primary distributor of choice for its expertise in everything from capital procurement, to OR workflow and space utilization, to kitting and SCO capabilities, all of which help ensure maximum efficiency and, ultimately, cost savings.

Beyond procurement and supply of disposable products, this pathway includes:

“SIA is collaborating with Medline to develop a strategy—from doors open to the first day of surgery,” says Hunter Carter, Account Manager for Ambulatory Surgery at Medline. “If you have an established pathway for center activation and know how to expedite speed to market, that is a huge value-add.

The tide is turning for ASCs in light of increasing surgical demand. As they continue to grow to meet these demands, ASCs will continue to evolve and coexist in different formats and specialties. As studies reveal, ASCs with established joint replacement programs are thriving—operating safe, scalable models that continue to show high-quality results. By looking into more ways of streamlining operations and making solid partnerships with proven financial and supply chain leaders, the ASCs of tomorrow may just lead the way in supply chain innovation.