What happens when the procedure that’s the No. 1 surgical cost for Medicare meets a pandemic? In the case of total knee replacements performed by Michael Lawson Swank, M.D., orthopedic surgeon with Beacon Orthopaedics and Sports Medicine, an improvement in patient care. COVID-19 was “an accomplice I didn’t expect to have,” says Swank. “It set the stage for people to rethink how they view health care and risk.”
Almost overnight, Swank discovered a change in his patients. Before the pandemic, most people wanted to stay in the hospital longer—only 50 to 60 percent of joint surgery patients went home the same day, when fully 80 to 90 percent could have safely been discharged. Swank saw that change rapidly. “[Most patients were] literally going home within three to four hours post-surgery and this includes patients up to 80 years old.” And Swank views that as a good thing.
“If we can do these things out of the hospital in an outpatient setting, we’re saving Medicare millions of dollars a year,” says Swank, who is the medical director of Cincinnati Orthopaedic Research Institute.
It’s not just the pandemic that’s led to the change. Beacon’s treatment protocols, developed to ensure patients get the best outcomes, paved the way. It starts before the surgery, with “prebilitation,” making sure patients are in good shape before the procedure. In the operating room, Swank’s muscle-sparing techniques—he doesn’t cut muscle—can help ease post-operative pain. As well, the use of spinals and local blocks instead of full anesthesia reduces nausea. Avoiding those complications eases a patient’s transition back home. But the work is not over.
“Your joint is not the same as it used to be,” Swank cautions. “It requires maintenance just like your car requires maintenance. It’s not a passive process.”
That’s where the app-based software program the multidisciplinary Beacon team uses comes into play. During the first six weeks post-surgery when patients are working on restoring range of motion, Beacon’s nurse navigators, anesthesiologist, and therapists use the app to communicate with their patients about their care, whether that’s seeing therapists, getting lab work done, logging daily steps, or seeing a primary care physician. Therapy visits are limited in this phase, but extended past the first six weeks to support patients as they work to rebuild strength.
“We can track these patients using a multidisciplinary, real-time record of what’s happening,” says Swank. “We’ve added this tracking and monitoring system so we can broaden our outreach even though we’re seeing people less frequently.”
Swank estimates that since COVID-19 started, he has performed between 500 and 600 outpatient joint surgeries, and he believes that some of the changes wrought by the virus are actually positive. “Many of my patients [who had the outpatient procedures] have come back and said, ‘Man, this is way better than I thought!’” says Swank.
“It goes back to the idea that the goal is not to fix something but rather to get someone back to walking so they can maintain an independent lifestyle and experience overall health benefits.”
Beacon Orthopaedics and Sports Medicine, 500 E Business Way, Sharonville, OH 45241. Dr Swank: (513) 530-3027; Schedule an appt: (513) 354-3700