![在你的网络中加入所有的关节之前,计划教育和应该知道的事情](/Areas/CMS/assets/img/blank.gif)
所以你决定在你的门诊手术中心(ASC)增加一个全面的联合项目. 这可能是一个明智的举动——持续的成本压力正在影响手术病例从医院转向门诊, 为bet8娱乐中心提供了建立新bet8娱乐项目的重要机会.
But a lot has to happen before a single case can be scheduled. “You need to get all your ‘what-ifs’ out of the way,” says Catherine Ruppe, RN, an associate principal with ECG. “你不想做你的第一个全关节,然后意识到你的植入物的商业付款人合同没有足够高的报销, and you end up losing your shirt.”
Prior to her consulting work, Catherine是ASC运营的执行董事, 太平洋西北地区22例ASCs的多专业外科实践, 她在哪里与高管合作,并为董事提供领导. Catherine解释了在ASC中添加一个完整的联合bet8娱乐线所涉及的内容.
Account for everything.
向ASC添加任何新的bet8娱乐线都需要大量的深谋远虑. 但计划一个全面的联合项目是完全压倒性的, Catherine says, given all of its moving parts. 凯瑟琳说:“当你第一次考虑启动一个全面的联合项目时,可能会让人望而生畏. “Take your time and think about everything—all the people, all the things that need to be involved, and make sure everybody’s on the same page.”
Surgeons and Staff
让所有人都达成共识可能是首要挑战之一. “你会遇到员工的阻力,甚至可能是一些外科bet8网站备用,”凯瑟琳说. Her organization established a total joint program in 2016, and she recalls that “some surgeons were on board, others were not, 这需要说服工作人员,因为很多人已经离开了住院病房,“转而选择不那么费力的日程安排,并希望处理不那么复杂的病例。.
Payers
There are external stakeholders to consider as well. ASC领导需要与付款人合作,以确保有利的报销总联合病例在门诊设置. It’s important to evaluate payer contracts, determine the implant costs, 评估任何高成本的一次性用品和耗材(特别是涉及机器人的情况)。. With total joints, the payer mix can often be 50% Medicare, 因此,这些情况下的任何潜在损失都应考虑到商业付款人的报销目标中.
Vendors
asc还需要与供应商就植入物和设备的成本进行谈判. “我们与供应商合作,简化了我们需要带到手术中心的仪器数量,“ Catherine says. 再一次,医疗保险人群需要考虑到与供应商的讨论. 当医疗保险的固定费率不包括植入物的费用时, 要求供应商与ASC合作定价,并努力降低成本.
Space
Space is also a concern. ASC的手术室需要足够大,以容纳联合手术所需的工作人员和设备. But the size of the OR is only one consideration. 凯瑟琳解释说,虽然ASC的典型术后时间约为两个小时, 关节病人可能会在手术后呆6到8个小时. Those patients “have to get up and ambulate. 在我们的设施里,我们必须考虑让这些病人在我们的手术中心行走的空间.”
Patients
And don’t forget about the little things. 更长的术后停留时间也意味着让病人在更长的时间里保持舒适. “We encouraged them to bring iPads if they had them. 我们还有一台电视,还有一台DVD播放机和几部电影, 但我们告诉患者,他们可以带一张DVD或使用他们的Netflix账户.”
Educate, educate, educate.
在讨论ASCs的全关节时,教育是Catherine经常提到的一个主题. “Education across the board” is essential, she says, so that patients, providers, 工作人员了解医院手术室的手术和ASC的手术之间的区别. Patients, in particular, 需要对环境感到舒适,并且知道安全是优先考虑的.
凯瑟琳指出,当外科bet8网站备用安排他们在ASC进行联合手术时,她和她的团队遇到了患者的“很多担忧”. “They would go home and say, ‘I’m going to have it done in an outpatient surgery area,’ and their friends and family would be like, ‘Oh no you’re not. That’s too dangerous,’” she says. “There was this perception of the Wild West, 我们在后院做手术,而不是在功能齐全的ASC里.”
在ASC进行联合手术的费用可能比在医院做要低, 但这并不是因为ASC忽视了患者安全措施或护理质量. “我不认为公众中的每个人都明白,许多asc是有执照的, accredited, and Medicare certified,” Catherine says. 我们的执照是由我们所在的州颁发的,认证机构和认证医院系统的机构是一样的. 我们必须遵守许多与医院为病人安全所做的相同的规则.”
bet8网站备用还需要了解在ASC中操作是不同的, and they’ll have to make some adjustments. “他们不会改变他们的手术方法或方案, but they have to think more clearly about pre-op preparation, post-op planning, pain control, things like that,” Catherine says. “通常他们会做手术,直到第二天早上才会看到病人. But in the surgery center, they’re coming to see them before they leave the facility, within a few hours.”
Involve everybody.
增加全联合bet8娱乐线会影响到asc外科bet8网站备用的每个人, staff, even non-orthopedic surgeons, whose schedules may be affected by the change. So it’s best to include everyone in the preparation.
“Involve everybody,” Catherine says. “你永远不知道谁会想出一个好主意或一种可能奏效的新方法. We worked the physicians to create the protocols, and we worked with staff to figure out our processes. 我们用我们的工作人员作为病人进行了多次演练, and each time, we found, ‘oh, we forgot about that,’ or ‘we didn’t think about this.” Because we involved so many people in the process, somebody covered every point that we needed, so there were very, very minimal tweaks we made after our first case.”
“It also engaged the team very much,” she continues. “Everybody was on board. Even from the front office, the schedulers, and the check-in people, all the nursing staff, pre-op, post-op, of course the OR team, materials, SPD.”
既然每个人都参与了计划,每个人都应该能够庆祝结果. “我们在手术中心做了第一个病例,这是一个重要的日子. We brought in lunch for everybody. It was the culmination of months’ worth of work, and it was just the beginning of what we’re doing, but we wanted to celebrate our successes along the way. 我认为,让员工能够畅所欲言,成为其中的一部分,参与其中,是非常重要的.”
Adding new cases to your ASC?
Here’s what you need to know.
Learn MorePublished April 6, 2022