(Gina) Hello, everyone.
Hi, everyone. Sorry about that.
Welcome to today's webinar: Why Pursue Joint Commission
Advanced Orthopedic Certification for your ASC.
I am Gina Doruff, Associate Director of Marketing for Ambulatory Healthcare.
I'd like to introduce our presenter for today, Zach George.
Zach is the Executive Director of Ambulatory Healthcare Accreditation
at The Joint Commission,
where he leads strategic planning, business development,
and external relations with professional and state associations.
Prior to his role at the ambulatory team,
Zach led the business development and strategic initiatives
for Joint Commission disease-specific care certification.
He was instrumental in launching
the Advanced Total Hip and Knee Replacement
and Advanced Certification in Spine Surgery programs
in collaboration with AAOS,
as well as initiatives to align care distinctions
such as Blue Distinction, Blue Cross Blue Shield,
and Institutes of Quality with Aetna
with achieving Joint Commission certification.
And before we get started, I want to go over a few items
so you know how to participate in today's event,
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And now I'd like to turn the call over to Zach. Zach?
(Zach) Well, thank you, Gina.
Thank you very much, everybody, for joining us today
to learn more about the orthopedic certification.
Orthopedic certification is something that has become highly effective
and very desirable for use by healthcare organizations,
especially ambulatory surgery centers.
And it makes all the sense in the world that this would exist.
I'll tell you a little more
about how certification is different than accreditation in a moment.
But just to set the stage, the importance of this certification,
the relevance is, for example,
perspective-wise, over the next 20 years,
hip replacements are expected to grow by 174%
and knee replacements by 673%
according to a study presented
by the American Academy of Orthopaedic Surgeons.
Degenerative spine disease is one of the most prevalent
and costly disease states worldwide,
with more than 1.2 million surgeries performed in the United States per year.
In 1982, outpatient surgeries represented
just 4.7%
of Medicare surgical billings,
and today,
53% of those surgeries are done in a same-day ambulatory setting.
We know that with the demographics of our population,
as well as the accessibility to healthcare,
as well as the advances that you all have made
in your ability to effectively
and efficiently replace these joints
and perform these spines procedures,
these volumes are definitely headed through the roof right now.
They work!
You have one member of the family will get a successful hip replacement
and will run to every other member of their family
and tell them they should get a hip replacement.
And it's because it does work.
And that's thanks to all of you
and the advances over the years
in the research and in the recommendations for care
and in the ability to perform these
in an outpatient session scenario
without admission into a hospital for three days.
Today, this surgical scenario is so much better for patients,
so much better for healthcare.
And it's only going to increase.
This is part of the reason
we begin to get together
with the American Academy of Orthopaedic Surgeons,
and we begin to review guidelines
from NAON and from neuro societies as well
to develop the most accurate
the most effective certification to help you all
have the most success in this arena with these procedures.
We also know that, in general,
it's tough being in the healthcare business today,
especially as an ambulatory surgery center.
Now, you all successfully have opened ambulatory surgery centers,
you're successfully running these surgery centers already,
but there are a lot of challenges facing us.
This is your patient,
and this is your ambulatory surgery center.
This represents your patients.
Your top priority and your number one concern
is delivering the best possible care,
the best quality-of-life improvement for each of these patients
based on their unique profile as a patient.
But you're dealing with some very challenging market pressures
that are making it difficult to do that.
Financially,
revenue is definitely impacted by reimbursement rates,
patient accessibility,
payer programs,
and definitely increased competition.
Costs are also increasing for supplies, services,
and staffing is a big cost in this current workforce shortage.
ASCs also are under intense scrutiny from the media,
from payers--
sorry, for the media, payers, regulators, your states,
and patients.
In this world, patients are much more likely
to shop, to go online and research.
Where should we go to get this elective procedure?
Their primary care physician may refer them somewhere,
but yet they still go online to research.
Increased scrutiny like never before in today's world,
and especially in the ambulatory space.
That raises the importance and profile of your quality reports and your ratings.
It's also hard to stay on top of all the regulatory
and industry uncertainty and change.
Who knows what's coming tomorrow?
Whether it's the political environment, whether it's a new news story,
whether it's a new lawsuit that grabs the headlines,
you just don't know what's going to come next that may affect you.
Now,
one of the ways joint replacement or spine surgery programs
address these pressures
is actually through certification.
With all these pressures going on, it is--
you're always looking for a way to stay strong
in the face of those pressures
and continue to be successful with your mission.
One of the ways programs like yours address or prepare for these pressures
is through certification in today's world.
You might look for an easier path or a cheaper path
which would be to not pursue certification.
But certification allows you to harness
the benefits of establishing an impactful relationship
with the premier orthopedic certification
through The Joint Commission,
which, again, is a collaboration
with the American Academy of Orthopaedic Surgeons.
The Joint Commission designed its Advanced Total Hip and Knee
and Spine Surgery Certification to focus on all the variables and processes
that are directly impacting patient outcomes
in order to minimize risk.
And that risk is the risk of unnecessary variation,
just unnecessary variation in an order set,
in a form that you process,
in your timeout.
This unnecessary variation is risk,
and it doesn't just include risk to patients,
but also the diminished reliability
of any financial forecast that you produce
related to the business itself from a business perspective.
This means your ASC, with the certification,
there are a lot of opportunities to lower the likelihood of patient harm,
and certification definitely addresses those.
That's how we were built,
and such as avoidable infections,
and other outcomes that eat into your margins
and put your reputation at risk.
There are so many...
unnecessary outcomes that happen still to this day,
but we're much better with things like wrong side,
wrong patient, wrong joint.
So much better, but still, these are there.
The goal with certification is to avoid those.
Certification is different than an accreditation.
An accreditation is very much by necessity,
really going around and inspecting
to be sure that the hospital is up to the conditions
for coverage with CMS,
as well as the physical plant and whatnot.
That is very necessary.
But certification is meant to be a qualitative review of your program
in order to identify areas where you can improve the quality of care.
This means applying the most relevant and current standards in healthcare
to evaluate your care environment.
You can also use this process
to figure out where you're most at risk.
This includes engaging your entire staff in the analysis
in order to make patient safety the highest priority.
And from there,
you can use the most current evidence-based guidelines
and best practices to improve processes,
minimize the possibility of harmful events,
and mitigate any known patient and staff risks.
When you take this approach, quality of care,
it truly becomes part of your culture,
because quality is everyone's job in a surgery center,
plus that type of a culture is far more rewarding
for each member of the staff.
Certification ingrains that into your culture.
It's just a very structured and effective way to do so.
It's almost a turnkey
for accomplishing that type of a culture.
You have confidence each member of your staff is doing the right thing
for the right reason to protect your patients, margins, and reputation.
That's what I wanted to talk about today.
There are a lot of ways, again,
that certification can help face these pressures.
One of the ways ambulatory surgery centers like yours
are driving sustainability, sustainable success,
has to do with the impacts that certification can have on revenue,
for example,
whether it be reimbursement rates.
There are payer programs, for example,
with Blue Distinction, Blue Cross Blue Shield,
as well as Aetna IOQ.
This certification is something that aligns with many of your refers,
whether they're accredited by Joint Commission, for example,
but it definitely can drive and be used to go out receive referrals.
It's definitely marketable.
It also helps with risk.
Again, the main premise of certification
is to remove unnecessary variation through standardization.
And again, that's unnecessary risk
that exists just because a process isn't standardized.
Efficiency and effectiveness.
That is largely based on, again,
standardization of processes and protocols,
but also, by being based
on the most current evidence-based clinical practice guidelines,
such as those from the American Academy of Orthopaedic Surgeons
and the neuro societies.
But another thing that our customers actually report
that this helps with the most
is staff recruitment and retention.
How relevant is that in today's world?
They cite multiple reasons for that.
One of the main ones is
the standardization itself creates an environment
where there is certainty for each staff member
about their role and about how they go about doing it.
It is formalized, and there's something dependable about that.
There's something--
They know what they're going to do when they go to work that day,
and it is the same each day.
Don't get me wrong,
not in a boring way, but in a predictable way
where they know what they will face each day based on the role they play.
But another one is,
when you have a certification in place,
and you organize yourself and standardize,
and also organize yourself
according to some of the improvement concepts,
this is another thing that creates
a very involved and inclusive environment for staff members,
as well as ongoing competency development.
Very interesting.
Something we found recently on research that I wanted to be sure and include
based on its relevance.
Quality and safety in general, these are not outcomes.
They are the means to an end of the results.
That's the essence of certification.
And again, that is why we--
The Joint Commission is not trying to be the surgeons or the clinicians.
We are based on building effective certification programs
and accreditation programs.
We are not going to create a program on our own.
Rather, we reach out to the American Academy of Orthopaedic Surgeons,
and we collaborate with them
to build a certification that they believe would be the most appropriate
for an ambulatory setting
that is performing joint replacements and spine surgeries.
I don't want you to feel as though this is a creation of Joint Commission alone.
This is collaboration with you, with all of you,
by way of the associations to which you contribute and are members,
the AAOS.
With that being said,
today, what we're going to talk about is just an overview
of our joint replacement, as well as our spine surgery programs,
the eligibility requirements for you.
I'll go over a few key standards and expectations.
And we'll talk about performance measures and the proactive improvement approach.
I will give you an introduction to the onsite review
so you can see how that's different than an accreditation review.
And then, the path to becoming certified is very efficient,
and I just want to give you a quick idea of what that looks like,
because again,
it's a far less intense preparation than you had to go through
when you initially achieved accreditation.
I'll start with what is certification.
By the way, this is a good point.
I just wanted to offer that,
in the event you have any questions that come in throughout,
if you think of a question
before we reach the end of the presentation,
go ahead and type it in.
Go ahead and type it into the message pane,
and I'll actually see it while I'm presenting,
and I'll go ahead and answer those as I go.
I just wanted to offer that to everybody.
What is certification?
Certifications are two-year programs.
They are a qualitative review of your joint replacement
or your spine surgery,
or both programs at your surgery center.
They are available to all ASCs that are in the United States
and are currently accredited by either The Joint Commission,
or another accrediting body,
that deems the site to meet the CfCs for Medicare.
That's the important thing.
You don't need to be accredited by us.
If you're accredited by AAAHC or QUAD A,
that's fine as well.
We just need to know you meet those CfCs for Medicare.
It is awarded at the site level.
And it is a qualitative review, again, of your program
focused on proactive improvement.
Certification itself has some key elements that you'll all understand.
The first is that your programs build
on the most current clinical practice guidelines,
recommendations of care.
The most current research being produced by AAOS,
for example,
you would want to make sure those are incorporated.
Performance measurement is also an essential part of certification
that formalizes the process by which you are tracking
key results that align with those guidelines,
the ongoing tracking and discussion of those as a team,
because the next step is, based on that measurement,
to be constantly developing a proactive improvement plan.
The nature of certification
is not that we have measures you need to hit,
and if you don't, you need to have a PI plan.
That is not proactive; that is reactive.
Our goal is to help you formalize your own processes internally,
where you go about monitoring performance and proactively identifying the plan.
And the final element are the Standards
that The Joint Commission has designed
for orthopedic certification, again, in collaboration with AAOS,
as well as the neuro societies.
That Standards manual is available online in today's world.
That is called E-dition, and I'll reference that at a later date.
All of these elements come together in an efficient certification process
that, again, is directly correlated with improvements in quality of care,
safety,
and even efficiencies operationally and financially down the road.
The advanced paradigm that we look at--
back in the day,
when we would certify a surgery center,
we would just certify when they arrive at the surgery center
through when they left the surgery center.
But what we all know is that
the ultimate outcome for a patient
has a lot to do with what happens before they come to the surgery center,
and it has a lot to do with what happens when they leave.
The advanced certification for spine and orthopedic
actually wants to see
what is the connection with the surgery center
to the pre-op office visit with the surgeon.
We're not certifying the surgeon per se,
but we want to learn what process you have between the surgeon
and that first consult.
What is the procedure from there to them arriving in the ASC
the day of surgery.
After the surgery,
we want to know what happens when they're discharged.
Primarily, discharged to home.
What is the process you have set up?
Which home health and outpatient therapy organizations
might you work with?
What do you have established with them?
All the way through the post-op visit with the surgeon.
There are key points throughout this entire domain
where the ASC is involved.
You design what this will look like with your partners,
and that's what we want to learn about when we come to visit.
That is a much more full and useful relationship
for us to review with you and your team.
We're looking for patient-centered care from consultation through follow-up,
standardization throughout this continuum,
again, removing unnecessary variation,
shared decision-making with the patient throughout this continuum of care,
collaboration among the clinical team,
and again, ongoing and proactive improvement processes.
The key requirements--
again, these are drawn up in collaboration with our collaborative partners--
the key eligibility requirements for Advanced Total Hip and Knee,
which is abbreviated THKR.
We just want to know that you are performing
both hip and knee replacement surgeries.
It is comprehensive.
We need to know that you're doing both.
Participation in the American Joint Replacement Registry through the AAOS.
But there are no annual volume requirements.
In order to be eligible for joint replacement,
we just need to know you've been open long enough
that you've served at least 10 patients.
For spine surgery, the second column,
that's abbreviated ACSS.
With spine surgery,
we just need to know you're performing laminectomy,
some discectomies,
fusion, and related surgeries.
We don't require that you provide all of these.
You usually do.
But we don't require you are performing all of these.
This is not an advanced laminectomy and discectomy certification
where you need to do both.
Those are the types of surgeries we are reviewing.
Participation in the American Spine Registry is required.
This one does have an annual volume requirement,
and that is the volume of 200 spine surgeries per year.
That's the current volume requirement we're looking for, for this certification.
Next slide.
As far as our standards go, we have six chapters, just six.
With your accreditation manual, you have 14, 15.
There are just six for certification,
and they're the same
for all of our certifications.
The first chapter, Certification Participation Requirements.
These are basically requirements that you generally meet
because you're already accredited by somebody.
But that is a chapter of requirements.
The main chapters, however, are the five that follow:
Program Management.
That's how you build your program and your team.
Delivering and Facilitating Clinical Care.
That has to do with how you standardize your practices--
I'm sorry, your processes and protocols
to achieve clinical practice guidelines.
Supporting Self Management of the patient.
That has to do with patient education
and shared decision-making.
Clinical Information Management.
That has to do with making sure
that the relevant information about a patient
is where it needs to be when it needs to be there
so we're talking about health record there.
Finally, Performance Measurement.
Performance Measurement also includes performance improvement.
I'll touch on each of these chapters in the next slides.
Program leadership in general is part of the Program Management chapter.
This is one of the key areas
that we want to learn about how you achieve at your surgery center.
Program leadership, in general, we just want to make sure
you have a leadership team that is focusing on the certification.
It's usually a handful of folks.
Depends on the size of your ASC, the way you're organized,
but in general, we'll always want to see there is a Medical Director identified
with regards to this certification.
That might not be their title with your surgery center per se,
but we do want to see you've identified someone
to be the Medical Director of your certification.
Other members of your leadership team include usually a CNO,
or you might have a Director of Quality.
You may have a navigator.
Again, each surgery center's a little different,
and you might choose to have two or three other people on your team,
or it might just be the one.
The interdisciplinary team.
I won't dwell on this, but basically, you're going to have a team of folks
that join that leadership team to monitor the performance of the program
and proactively identify areas for improvement over time.
We do want it to be interdisciplinary.
You try and include each of the disciplines
that you have available at your surgery center.
From a clinical practice guidelines standpoint,
when we're there, we want to see that you are following
the most current evidence-based clinical practice guidelines
through the continuum of care.
We're looking for guidelines
that address the evaluation and optimization of the patient
prior to operation,
as well as post-operative care,
anesthesia, early mobilization,
pain management, and such.
For Advanced Total Hip and Knee,
the two primary sets of guidelines were looking for are those created
by the American Academy of Orthopaedic Surgeons.
As you all know, they have a set of guidelines
for the management of osteoarthritis of the hip.
They also have a set of guidelines
for the surgical management of osteoarthritis of the knee.
Those are the two primary sets
that you are surely already based upon.
That's one thing we'll confirm when were there.
Your processes and protocols are aligned with those guidelines.
Another set of very popular and very useful guidelines are
those guidelines that are published
by the National Association of Orthopaedic Nurses as well.
The two sets, they go hand-in-hand
to really include a much more full set of guidelines.
For spine surgery,
where obviously there's several groups,
you'll recognize those of the American Academy of Orthopaedic Surgeons,
but also the North American Spine Society.
The National Association of Orthopaedic Nurses
is also there with regards to spine surgery.
But then, the American Association of Neuroscience Nurses
also have good guidelines.
So there...
You might not use all four sets. You might just use two.
We just want to know which of those you've incorporated in your program.
Throughout this certification,
again, we're really looking for uniformity and standardization
of your processes and protocols based on those guidelines.
And we're looking for consistency of all the clinicians and the office staff
with regards to those guidelines.
No significant outliers.
Again, the order sets are a great example where standardization is helpful.
And consistency of all interdisciplinary areas
throughout that continuum.
All right, as far as assessment and evaluation of the patient,
we definitely want the program to be able to track
what was the health
and what was the functional status of the patient prior to surgery
to get that baseline and also to optimize the patient.
Then you want it to reassess the patient after the surgery
to see what your functional outcomes, how those actually look.
That's the ultimate way to track success in many cases.
For Advanced Total Hip and Knee,
the assessments that we expect to see when we visit
that are being performed pre- and post-op,
for general assessment,
we're looking for either the Veterans RAND 12, the VR-12,
or the PROMIS (Global-10) assessments.
That's for general assessment.
We're also looking for a functional assessment,
and that would be either the HOOS/KOOS or the HOOS/KOOS Jr.
assessment for the functional.
Again, you do that prior to surgery and then again afterwards
to see where you ended up post-surgery.
For spine surgery,
very similar, for general assessment, we're looking for the VR-12 or the PROMIS,
and for functional,
the Neck Disability Index, the Oswestry Disability Index.
The Numeric Rating Scale is also helpful.
Again, for functional,
we're really looking that you're using
at least one general and at least one functional assessment.
For patient optimization,
we just want to learn
what is your approach to optimizing a patient pre-surgery.
What steps have been taken to ensure they're optimized?
Where does that optimization take place?
Who is involved?
How is everything communicated between the surgeon and the ASC?
Where's the documentation and evaluation included
in the patient's medical record?
Everyone does this a little differently,
and we really want to just learn about, at your surgery center,
where does the assessment take place.
Is it at the surgeon's office? Is it at the surgery center?
Is it in a meeting between the two?
What works best for you?
What did you standardize?
And how does that take place at your surgery center?
In the Supporting Self Management chapter, we do talk about patient education.
The main things we want to see in patient education
is that patient goals are being established
and that there is education being provided to them with regards to their condition,
the alternative courses of care,
what is the nature of the procedure they are about to pursue,
as well as the anesthesia,
as well as preparing them to be discharged home,
and to behave and to follow the instructions you have provided
in order to maximize their successful outcome.
For performance measurement,
again, both of our certifications for joint replacement and for spine,
they do require participation in a registry.
Registries are fantastic.
They're widely used in so many service lines,
and they're readily available at this point in time in orthopedics.
We have you're required to participate in a registry.
They'd reach out the AJRR and the American Spine Registry.
You would learn from them
the type of information they want you to submit to the registry.
You'll go through that process.
Now there's quite a few reports and dashboards and tools
those registries offer you that are very helpful.
But what we do after you're working with the registry
and submitting data to the registry,
the registry will actually calculate some key measures
that The Joint Commission also wants to calculate,
or I'm sorry, also wants to capture.
Registry will calculate many things for you.
There's a small subset
that we actually want you to share back with The Joint Commission,
but the registries will calculate those for you.
Those are our standardized measures,
which I'll show you on the next slide.
Basically, after the registry calculates the measures,
you just type them into your Joint Commission portal.
It's a pretty easy process.
But I just wanted to point out how that works.
You submit the data the registry need.
They'll calculate the measures we need,
as well as many other measures for you that are useful.
Then we'll ask that you just type those into your Joint Commission portal,
just the result.
Take you five minutes.
I want to point out also that when you do apply,
and as you're learning about the certification
and you're applying,
we don't require you upload any data on these performance measures.
We just need to know you signed up for the registry when you apply.
And when we do come to visit for the initial on-site review,
we'll want to see just the most recent four months of results
on The Joint Commission measures.
Let me show you what those measures are.
For Advanced Total Hip and Knee,
we measure the proportion of your patients
to whom you incorporate regional anesthesia--
so folks you don't go straight general anesthesia with.
You may use general,
but we want to see that you've incorporated regional as well.
Post-operative ambulation on the same day of surgery.
The proportion of times you achieve that,
the proportion of those folks that you're able to discharge home,
and obviously, in a surgery center, that's going to be exceptionally high.
Then we'll also measure the proportion of times where you are successfully able
to achieve the pre-operative functional and health assessments,
as well as the proportion of time you're able to complete
the post-operative functional and health assessments.
One thing I want to point out on all of these measures,
as we have you track these measures
just so you can monitor your trends over time,
we don't set a threshold
that you have to hit on any of these measures
in order to qualify for the certification.
Every site is different.
Every community they serve may be different.
And some folks
might find that they are having more difficulty
with one of these measures than a different site.
As a result, we just want to know that you're tracking what your numbers are
on each of these.
Sometimes the numbers will go up. Sometimes they'll go down.
We just want to know
that you're able to tell the story of that trend over time.
It's not like there's a metric you have to hit on regional anesthesia
to qualify.
We just want to know what your metrics do look like over time
and what your interpretation of that trend is.
For spine surgery,
we got to track surgical site infection rates;
new neurological defects,
defects that did not exist prior to surgery;
unplanned return visits to the OR;
and then any pre-operative
and post-operative patient reported outcomes.
Again, same thing here,
you'll be interacting with the Spine Registry.
They will calculate many measures for you.
These are the four that we'll have you provide to The Joint Commission as well.
Again, it's just a process where you open your Joint Commission portal,
you have your Spine Registry screen open,
and you just type these numbers into your Joint Commission portal.
Again,
not all the data, just the final results.
Again, it doesn't take long to do that.
Five minutes.
For performance improvement planning,
we have you write a plan, but it takes the form of five questions.
I'll actually provide you with a template of those questions
so you can draft responses.
But in general, we want to set some goals and objectives.
We usually expect between three to five goals to be identified.
Some of the most common examples or topics where people might have a goal
would be standardized performance measures.
They might say, "We want to make sure that 90% of the time, at least,
we're using regional anesthesia."
But you might also identify goals that are not performance measures,
so rate of infection;
visits to the ER;
staff compliance with your processes and protocols
are often identified as goals;
patient education;
participation in your joint class before they come and have their surgery.
For example, often a goal is set by a program
to increase that patient education participation.
One of the biggest ones that's the most helpful
is patient satisfaction.
A lot of organizations will say,
"Our goal is to achieve a score of 4.5 out of 5
on our patient satisfaction surveys."
Others might say, "We want to make sure 90% of our patients
complete a patient satisfaction survey,"
and so on.
The goals and objectives are really up to you to identify,
and that way, they're the most relevant to you,
and they also do represent actual areas for improvement.
Because the next thing we do is we just have you summarize
the activities that are currently under way
to help you achieve those improvement goals.
You don't need to write a novel
on how you're going to achieve these goals,
just a summary on the improvement plan.
When we're there in person,
you'll be walking around with a peer of yours,
and it's much easier to share the details
while the two of you are together in person.
And then, for a quick review of the onsite review.
The onsite review, again, as I mentioned,
it's very different than an accreditation survey.
I do want to point out
these reviewers are subject-matter experts in joint replacement or spine surgery.
We do have a couple of surgeons, and the other folks are key nurses
that have been involved in joint replacement programs
or spine surgery programs like yours.
They're able to provide--
and they do a lot of surveys each year--
they're able to provide best practices that they've seen in other organizations.
These are educationally focused reviews of your program rather than an inspection.
It is the collaborative engagement, again, really based on learning together.
And from these onsite reviews that I have witnessed,
they are actually meant to inspire staff,
the entire staff, everyone they meet,
and really inspire them to validate the great work they do
and to leave there with everyone feeling...
like they're an important part of this path to performance improvement.
We'll just want to see that you're able to consistently apply
The Joint Commission standards
and the clinical practice guidelines that you've identified.
The nice thing about your initial onsite review
is that when you apply, you actually tell us when to come.
It's not one of those things where you apply,
and we call you from the parking lot a week later,
You tell us when to come.
You will receive 30-days advance notice of that initial review.
We usually ask that your ready date
is at least four to six months after you apply, by the way.
Again, this is not usually qualifying...
I mean, this is never qualifying you to be deemed by CMS.
For that reason, we ask that you give us at least four to six months
so we can get you scheduled,
and we can come out and visit right around that.
Again, for your initial onsite review, when you apply,
we don't need to see any data on your performance measures.
When we come to visit the first time, we'll just want to see
your most recent four months of data for performance measures.
It is just one reviewer, and they stay for two days.
On one of those two days, they'll want to observe a surgery.
I won't dwell on this too much.
I can tell you that the onsite review itself
is very much a tracer of methodology.
And that's where,
as we're learning about the processes and protocols that you've established,
we'll go ahead and we'll be with you, we'll learn about how each station
along the continuum of care operates, what you've established.
Then we'll trace a few patient records through
just to see how those work.
That brings it to life.
We see that with you, together, we select some patients through.
The nice thing about this is
we get to engage with you and members of your team to learn
about what they do at their station
and make them feel included in the overall experience.
Engagement and discussion will take place
throughout this entire tracing...
setting.
The typical agenda-- again, it's two days.
You start with an opening conference.
There is an opening conference where you introduce yourself,
and then, the reviewer will also share
a little more detail about the agenda and how the survey works.
You'll do individual patient tracers.
Again, as you're touring them around your program,
they'll trace patients through.
And then we do have a session
where we will look over competency and credentialing of key employees.
Towards the end of the survey,
we actually have a special issue resolution session.
Anything that we found together with you
that we might require be improved,
a lot of those things you're actually able to resolve before we even leave.
And that's the nice thing about the certification.
From a closing conference standpoint,
that's where the reviewer spends time with you and your team to summarize
the certification experience
and the RFIs that may have been identified for your organization to resolve,
as well as how those might be resolved
and how to go about documenting they have been completed.
You have a 60-day window to actually resolve any RFIs.
Finally, the best thing is, at the closing conference,
you actually do know your final result.
And what's nice is you don't have to wait a week
for the reviewer to leave and get back to you with your result.
You actually know before they leave.
And in all reality, there are no surprises,
because you're spending the day or the two days with this reviewer.
You're really finding things together.
If there are any RFIs to be resolved, you find them together.
The closing conference is nice because it truly does let you know
where you ended up at the end of the onsite review.
We have a Review Process Guide
that can definitely walk you through everything that will take place
during the onsite review.
We'll be sure to provide that with you,
but we're also here to talk you through that as you prepare.
And last but not least,
the application process.
The main thing you want to do is you want to be sure and...
reach out to your Associate Director.
If you just email ahcquality@jointcommission.org,
you'll have a special Associate Director that will work with you
throughout this application and learning process.
That will be your point of contact as you go through the whole process.
Prior to the application, we get you a copy of the standards,
and we help you go through reading the standards,
identifying any gaps.
You'll want to learn the performance measures,
and we give you the specifications for that, answer your questions.
You'll just reaffirm the clinical practice guidelines that you currently follow.
We'll help you do that five-question performance improvement plan.
We'll give you guidance on how to do that anyways.
You'll establish a ready date,
and you'll want to make sure you have signed up for the registry.
That's what you do pre-application with us.
To complete the application on the Connect portal,
that takes at most an hour.
We would actually like to do that with you.
We schedule a time and log into the portal with you.
That way, we can provide a bit of orientation about the portal,
but also, we can teach you how to do that while you're doing it.
You don't need to learn it on your own.
Finally,
you'll prepare for the onsite review using that Review Process Guide.
When you receive your 30-day advance notice,
we'd ask that you put your most recent four months of data in the portal.
Go ahead.
The last step is to advertise your achievement.
Again, this is very marketable.
This is a surgery center that's right on Lake Shore Drive
here in Chicago.
And any time you drive by this,
you'll notice they have this giant sign hanging on the side of their building
that says, "First in Chicago. We are certified.
We have orthopedic certification."
And this one in particular is joint replacement.
It's very marketable.
People see that when they drive to work,
and then they start thinking, "You know, my knee does hurt,
and I have a cousin who had a surgery that went well.
I'm going to ask my doctor about this at my next..."
My point is make the most of that.
That's something that we can definitely share,
what we've heard other organizations do
to advertise this certification in this competitive world.
With that, we only have a few minutes left.
I did notice... Oh, yeah.
A few questions may have come in.
Okay. So go ahead, Gina.
(Gina) Yes.
Just a reminder, if you have questions,
submit those via the Questions panel on the right side of your screen.
The first question we had that came in is,
"What if we receive our scheduled date,
and we do not have a procedure on either day of the survey?"
(Zach) Okay. Good question.
So one thing.
When you do apply, we actually have you identify
which days of the week you perform surgeries.
If it's just Tuesday and Wednesday, for example,
then we would schedule your review for Tuesday or Wednesday.
You also receive 30-days advance notice of the onsite review
so you can try and make sure you have something scheduled
for those days.
Again, we're going to make sure at least one of our days is on a day
you have surgery scheduled.
If the week comes up,
when it's a week out, and you have nothing scheduled,
and you're pretty sure you won't be able to get anything scheduled,
then you just need to contact us right away,
because we wouldn't want to visit if there's no one to observe.
But in the end, we have a lot of safeguards up front
to make sure we're not scheduling on a day when you would never have surgery.
(Gina) Okay.
Next question is, "Can you speak more about the pre and post health assessment?"
(Zach) Yes, those [inaudible] the health assessments
and the functional assessments prior to surgery.
The health assessment in general obviously is very important
for understanding your patient's overall health.
Hopefully, you have the ideal patients coming through an ambulatory...
center.
I'm sure you usually do.
Hopefully, not the most complicated cases,
because those might go to a different environment
for their surgery.
But you want to make sure you're doing that health assessment,
again, so you understand how to optimize the patient pre-surgery.
If they're diabetic, if the blood pressure is there,
if their BMI is off the charts.
There are things that you medically may decide
you need to optimize prior to the operation.
That's the reason
we want you to be using either the VR-12 or the PROMIS
to assess that health and to assess the patient overall
prior to performing a surgery.
At least you've done the assessment and discussed it as a clinical team.
The functional assessments are important,
because obviously, they give you even more insight
to their actual state of their osteoarthritis or their condition
or their spine condition.
It also provides a baseline
that you can then measure against post-surgery.
That is why we ask that you use these standardized assessment tools
that we identified on that previous slide,
which are HOOS/KOOS or HOOS/KOOS JR. for hip and knee,
as well as those indexes that we identified for spine.
(Gina) Okay, we have another question that came in.
"What is the requirement for data entry?
Our center does over 90 total hips and knees per month.
Would we have to enter data
for all of these or a percentage of these?"
(Zach) Oh, glad you asked.
Again, that's something that will be determined by the registry.
The registry will talk about the data that they need,
whether there's a sampling or not that they need,
and that's where you'll know,
"Okay, here's the amount I need to provide to the registry."
For Joint Commission, you do not need to...
you'll just type in the final result for the month.
For the registry,
they'll talk to you about what sampling may be appropriate
based on your population that you serve each month.
(Gina) Okay, I think we have time for one last question.
"Can a center do accreditation and certification at the same time?"
Well, usually, it's hard to overlap the two.
The only reason why is because that...
They are two different...
The nature of that onsite visit is different.
The accreditation itself is
all the requirements necessary to actually become accredited.
So environment of care, life safety, infection control, and so on.
The certification review, again, is much more a qualitative review
of how you've built your joint replacement program.
The two are different enough that I...
We wouldn't be able to do just one survey.
They would be separate surveys.
And doing them at the same time,
it really wouldn't be...
And by the way,
remember, one of the requirements to be certified
is that you're already accredited.
We would need you to get accredited before you could apply.
If you're already accredited
and you're having a re-survey for your accreditation,
you still wouldn't want to do your joint replacement review
at the same time.
You'd want to do them separately.
That's really just for your own sake and for the sake of making sure
both of those are as effective as they can be
and as useful as they can be.
(Gina) All right. Well, thank you, Zach.
We are at the top of the hour,
so we are going to conclude today's webinar.
However, if you have a question,
feel free to email us at ahcquality@jointcommission.org
You'll also receive an email within the next 48 hours
that has that email address on it, so feel free to respond there.
You will receive, and along in that webinar will be on-demand webinar
and the deck.
Thank you all for taking the time to join us today.
On behalf of The Joint Commission,
thank you for joining us today and have a great rest of your day.