Second installment on state-of-the-art Oregon Surgical Institute’s first-year success

With just over a year in operation as Oregon’s first ambulatory surgery center dedicated to total joint replacement (TJR) and other complex orthopedic procedures, the surgeon-owners at Oregon Surgical Institute (OSI) have honed processes related to patient experience and patient selection, along with a common core of protocols across the board, to establish the center as a respected destination for high quality outpatient treatment.

Two of OSI’s partner surgeons, Dr. Jim Ballard and Dr. Chris Nanson, sat down recently for a questions-and-answer discussion about the differences between the ASCs and hospitals when it comes to patient selection, experience, and outcomes.

Question: What patient selection/education process is in use at OSI?

Answer: “Because we’re not operating within the hospital, we have a fairly comprehensive list of disqualifying factors,” says Dr. Nanson, “They need to be healthy, any chronic conditions need to be well controlled, and if there are any questions about medical fitness for surgery, we involve our anesthesiologists to help determine if the patient is appropriate for the ambulatory setting.”

But beyond medical requirements, Dr. Nanson says there is a social piece to patient selection as well. “We require patients to assign a support system – to have a family member who will sign a coach contract, and we need assurance they have a safe environment at home. With outpatient, it’s very important to ensure they have support, transportation, and a good setting where they can safely recover.”

Medically, Dr. Ballard explains there is a surprisingly large segment of people that can undergo TJR in the ASC environment. “More than you would think; it’s not just for the super fit,” he added.

Question: How is the TJR patient experience different in an ASC vs a hospital?

Answer: A big part of the experience difference is the physical space.

“When you can bring them to an environment that’s beautiful, that’s obviously not a hospital, all the cues are different,” Dr. Ballard says “They feel so much better, they don’t feel like a sick person, they’re just here for the day. They get a whole different vibe. And, that translates directly into how well they recover.”

Another difference is the way patients interact with staff at OSI. “We get them involved in our HealthLoop patient engagement software system,” says Dr. Nanson.  “It’s an app that pings them when they need to share information or take action pre-op, and serves as a portal for post-op communications, too. It’s a great way to involve the patients, and to serve them well even in a high-volume, outpatient center.”

OSI is the first ambulatory center in the nation to use the whole HealthLoop program, which is a product from Zimmer BioMet. Dr. Nanson believes it helps patients gain confidence, engages them, and effectively triggers coordinators to reach out when a patient needs help. “It’s a great way to help make sure everything goes as smoothly as possible, and to maintain control of the episode of care.”

Finally, since OSI surgeons are also owners, they can add personal touches to further differentiate the ASC experience. Dr. Ballard offers this example: when in recovery at OSI, every patient and their family is served food from a restaurant of their choice. In addition to a great meal, they have a chance to meet one-on-one with a physical therapist and interact with the total joint coordinators. “The OSI experience has been universally applauded by every patient we’ve had so far,” Dr. Ballard says.

Question: What advice would you offer to other doctors considering making the move to the ASC setting for total joint procedures?

Answer: Dr. Nanson: “I think the toughest thing is getting everyone to agree on a care pathway. And then, everybody on the team has to consistently help the patient know what to expect, what’s going to happen … everyone has to be onboard.”

“Building a center like we have, from scratch, is a lot like building the next moon colony. I mean, it is complicated. Like any new business enterprise, it’s full of ups and downs, failures, and hiccups. You’ve got to be ready for that,” Dr. Ballard says. “If you can commit to that, welcome to the next frontier! We’re at an inflection point, and this is a paradigm shift. As a total joint surgeon, I know it’s going this way. It is just a matter of whether people will pioneer it in their area, or if somebody else will do it for them.”

For more information about Regent’s partnerships in total joint replacement, click here.