Monterey, CA, December 30, 2016 — Thomas Wilson, CEO of Monterey Peninsula Surgery Centers, one of the largest locally owned and operated outpatient surgery organizations in the U.S., has long played a leading role in promoting the benefits of outpatient surgery.
The work of industry leaders Wilson and MPSC is symbolic of what the Ambulatory Surgery Center industry can achieve, and was spotlighted in a recent article published by the New York Times. The article discusses the ongoing debate over whether Medicare should pay for knee replacement surgery in free-standing surgery centers or outpatient facilities. Wilson, past-president of the Ambulatory Surgery Center Association (ASCA), presented compelling evidence to support this assertion including a lower infection rate when compared to surgeries performed in a hospital setting, sky-high patient satisfaction scores and significant cost savings.
This could save Medicare hundreds of millions of dollars annually. MPSC, located in Monterey, California, performs approximately 200 total joint replacement surgeries per year, with infection rates three times lower than similar surgeries performed in hospitals. The age of patients receiving total joint replacements at MPSC ranges from 38 to 82 years old, with the average age of 59. This compares to the national average of 62. He asserts most patients receiving a total joint replacement are not sick and do not need to be surrounded by sick people and thus an outpatient facility is an ideal choice.
How can you tell if a person is a good candidate for outpatient joint replacement surgery? Wilson says the best candidates have a low to moderate body mass index, healthy heart and lungs and a good social support system. A patient meeting these criteria is teamed with a friend or family member who functions as a coach. The patient and coach attend an educational session before the operation and learn about the anatomy of the procedure, how the patient's pain will be successfully managed without opioids or narcotics, and will undergo the recovery process in the comfort of their own home. The major difference in outpatient surgery is that the patient spends one night in the facility and goes home with a physical therapist visiting the patient soon thereafter. According to Wilson, this is possible because of surgical advances with minimally invasive techniques and the use of long-lasting, non-addictive anesthetics. Many hospitals are adopting these innovations and sending total joint replacement patients home after one or two days in the facility.
As a leading proponent of ASCs and outpatient surgery, Wilson was contacted by the New York Times to represent the ASC industry and relate MPSC's experience with TJR cases as it relates to Medicare's position on outpatient knee surgery.
A debate has been raging nationally in the medical community regarding this issue, with physicians weighing in on both sides. The Times' story said the issue “is sowing deep discord in the medical world, and the debate is as much about money as medicine.”
The article noted that demand for knee and hip replacement surgery is growing — 1,000,000 are performed each year in the U.S. — and that number is likely to grow to three million annually by 2030, “making these complex and expensive operations some of surgery’s biggest potential growth markets,” said the Times.
The article headlined “Should Medicare Allow Outpatient Knee Replacement? Doctors Are Deeply Split,” was written by Christina Jewett, a senior correspondent for Kaiser Health News, and was posted to the newspaper's website on Dec. 20 and appeared in print on Dec. 21 on Page B1 of the New York edition.
Presented with such evidence by Wilson and board certified orthopedic surgeon Sohrab Gollogly of Monterey Spine and Joint in 2016, the Health and Human Services (HHS) Advisory Panel that recommends outpatient payment policies to Medicare officials, unanimously recommended that Medicare remove the total knee replacement procedure from the inpatient only list, effectively allowing it to be performed in the outpatient setting.
Opponents of the change by Medicare say that there are concerns that moving surgery out of hospitals will force vulnerable patients into emergency rooms with uncontrolled pain, blood clots or other complications.
But proponents such as MPSC's Wilson say the change will give patients more choice and potentially better care and save Medicare hundreds of millions of dollars. And, according to recent rule-making documents, an “overwhelming majority” of those who commented said they want to allow the operations out of hospitals.
In December 2016, the Secretary of HHS did not adopt the recommendation. However approval could occur in 2017 under the Donald J. Trump administration. President elect Trump and Tom Price MD, his selection for Secretary of HHS, have suggested they favor limiting government controls and fostering innovation and increased competition in healthcare.
In recent months, Medicare has shown a strong interest in outpatient knee replacements, noting the potential for “overall improved outcomes” as well as the potential savings for the government program.
Many doctors, however, caution that not all patients are candidates for outpatient surgery, such as those who are frail or have chronic health issues, live alone or in a dwelling with stairs, and don't have good caretaking at home.
“While we realize this can be good for some patients, it’s not for all patients and all locations,” says Dr. Thomas C. Barber, the chairman of the American Academy of Orthopedic Surgeons’ advocacy council. Wilson agrees that outpatient total joint replacement is not for all, however to deny it to those who seek it is unjust and unwise public policy.
About Thomas D. Wilson
Mr. Wilson is CEO of the Monterey Peninsula Surgery Centers, which has partnered with two local hospitals and 90 surgeons and is one of the largest locally owned independent surgical services organizations in California. He leads the Minimus Institue, the destination medicine division of MPSC, as patients have traveled from 47 states and 10 countries for outpatient surgery at MPSC over the last five years. Wilson and Scott Leggett founded Global 1, one of the largest medical service organizations in the country providing commercially insured transparent all inclusive Bundled Payments through a network of 53 ASCs and over 350 physicians in California.
Mr. Wilson is a past president of Ambulatory Surgery Center Association, the California Surgery Center Association and is Insurance Commissioner Dave Jones’s appointee to the California Insurance Guarantee Association Board of Governors.
Tom Wilson received his undergraduate degree from Utah State University and a master's degree at the U.C. Berkeley Hospital Administration program.
Background on MPSC:
MPSC and its surgeons are recognized leaders in outpatient surgical care as measured by the high demand for its services, extremely low infection rates, 99% patient satisfaction scores and affordable, transparent pricing. It is known for performing complex surgery, including total joint replacements, major spine surgeries, hysterectomies, breast reconstruction and thyroidectomiesin the outpatient setting. In excess of 31,500 surgical procedures in 13 specialties are performed annually at MPSC by its 190 physicians on staff.
About Minimus Institute:
Wilson also founded and heads the Minimus Institute, a national state-of-the-art concierge surgical institute located in a beautiful setting on California's Central Coast, providing patients access to world-class surgeons. Offering transparent pricing and clear, comprehensive outcome information and patient-satisfaction scores, Minimus demystifies the surgical-care experience allowing patients to make the most informed decisions about their care.
Marci Bracco Cain
Salinas, CA 93901