Outpatient Total Joint Replacements? PT is Key
LAS VEGAS, NV -- In western Pennsylvania, an enterprising group of physicians is performing total knee and hip replacements in a select number of outpatients, and sending them home just hours after the procedure.
How does PT fit into the picture? This game-changing protocol relies on a hefty dose of skilled nursing and physical therapy involvement to be successful.
“This is an exciting topic, and without therapists this doesn’t happen,” related Christopher McClellan, DO, orthopedic surgeon and partner in University Orthopedic Center, a five-physician practice in Altoona, Pa. McClellan, who’s been in practice for 9 years and specializes in total joint procedures, delivered the presentation “Same-Day Outpatient Total Joint Replacement and Treatment” along with Dan Casillo, MPT, at the APTA’s Combined Sections Meeting Tuesday morning Feb. 4.
A nurse and physical therapist are waiting for the patient at home following discharge from the ambulatory surgical center just hours after the procedure, said Casillo, who went on to outline the specialized rehab that follows -- which involves more acute-care responsibilities in the first few days.
McClellan told his audience of mostly home care therapists that the idea came to him after realizing that many of the patients in the hospital after total joint arthroplasty did not need to be there, and would have rather been home.
“It’s just a change in thinking,” he said. “Thirty years ago you couldn’t walk on [a replaced joint.] That changed.” Moving to this new paradigm will require a similar willingness to challenge established protocols.
The program is not for everyone – patients are carefully screened for health status, BMI, home and family support, and other variables critical for success. And Medicare has yet to come on board – the 85 patients that have undergone the protocol to date have all been private-insured.
But once word begins to spread, and greater numbers of surgeons, therapists and insurers realize the cost savings, the safety to the patient (McClellan stressed negligible readmission and ER rates, along with reduced incidence of hospital-acquired infections), and most of all, improved patient satisfaction and scores, outpatient total joint procedures figure to be the wave of the future in medicine.
“This is accountable care at its highest level,” said McClellan. “Isn’t this the goal of health care?”
Look for more details surrounding this program in our next cover story.