Both health system and physician leaders need to have clear goals for the partnership. By articulating those goals explicitly, both parties understand their contribution to the venture and can prioritize decisions based on one another's goals. The result is clearer communication and greater alignment.
Hospital leaders contribute to the joint venture through financial support and operational management. Health systems’ scale enables them to foot the cost of developing the ASC facility, which is often more costly than physician groups can support independently. Hospital leaders also spearhead facility design and provide hospital support for cases that are ineligible for outpatient care or require transfer to the hospital. Physicians, for their part, control clinical design of the program. And by partnering with the health system instead of pursuing the venture independently, physicians allow hospitals to retain joint replacements within their systems.
Mutual benefit of partnership drives BJIT stakeholder alignment
BJIT’s leaders built hospital-physician alignment by recognizing and leveraging the mutual benefit of the partnership. After a decade of practicing with a major academic medical center (AMC), BJIT’s physicians sought to reestablish themselves as community leaders in Franklin, Tennessee, where the group was founded in 1979. Franklin-based Williamson Medical Center was the ideal partner—an orthopedic center of excellence and community hospital that was grappling with how to retain joint replacement cases given the outpatient shift it was seeing in its market.
The ASC partnership enabled each party to achieve its core goal. BJIT’s physicians received financial and facility design support from the hospital in building its outpatient facility and ASC, while the hospital received the physician support needed to keep joint replacement volumes within its system.
Virtua alignment rooted in successful hospital co-management
Virtua’s hospital administrators and physicians developed trust and open communication during their long-standing co-management of the hospital-based Joint Replacement Institute, a high-volume orthopedic center where Virtua’s physicians oversaw clinical operations and honed their outpatient care protocols.
This co-management model helped Virtua and its physicians achieve a 95% same-day discharge rate in their hospital outpatient department by 2017. This success at minimizing length of stay for hospital-based patients gave Virtua’s leaders the confidence they needed to partner with their physicians on ASC joint replacement. Virtua enabled the physicians to shift greater volume to the ASC by covering the capital expenses of expanding capacity at its Vantage Surgery Center, which at that time supported only lower-acuity services like arthroscopy and hand surgery.
Close alignment with anesthesia enables rapid ambulation
Trusted anesthesiologists are also needed to help ensure clinical readiness for ASC joint replacement, as early ambulation in the ASC requires waking patients more rapidly than is standard in the hospital. BJIT found this partner in Specialty Anesthesia of Tennessee, a group that traditionally performed sports medicine cases but trained itself in ASC-based joint replacement cases to prepare for the endeavor. This partnership has helped BJIT limit patients’ average time in the recovery room to just 90 minutes, minimizing the likelihood that patients require a penalty-heavy transfer to the hospital.