ASC Solutions · to us it’s more than saying we can provide efficiency and value, it’s proving it through a customized experience and measurable results. being your trusted partner

ZIMMER BIOMET

ASC Solutions

Results You Can Measure.A Partnership You Can Trust.

TO US IT’S MORE THAN SAYING WE CAN PROVIDE EFFICIENCY AND VALUE,

IT’S PROVING IT THROUGH A CUSTOMIZED EXPERIENCE AND MEASURABLE

RESULTS. BEING YOUR TRUSTED PARTNER MEANS GIVING YOU TOOLS TO

MANAGE THE PAIN POINTS IN YOUR PRACTICE THE WAY YOU WANT WITH

SOLUTIONS THAT DRIVE PROFITABILITY, MINIMIZE WASTE AND SUPPORT

COORDINATION AND COMMUNICATION IN THE ASC.

what is aTRUS TED PARTNER?

we can be YOUR PARTNER

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• Providing a complete solution for adding or optimizing an orthopedic service line

• Helping manage costs throughout the episode of care

• Offering a comprehensive portfolio of clinically proven implants

• Supporting medical education and patient awareness

We offer products, services and technologies spanning across the

musculoskeletal space and continuum of care. Whether you’re looking

to open a new facility, add a service line or enhance efficiencies, we have

options to help address the most common clinical and economic challenges

you face in an ASC.

MANAGEMENT SERVICES

Benefits of an outpatient program

Expanding your practice into an outpatient settings offers many benefits for

you, your staff, and your patients.

• Patients appreciate recovering in the comfort of home and reduced

exposure to potential pathogens

• Physicians appreciate increased efficiencies, autonomy and patient satisfaction

• Care teams appreciate collaborative care and clear expectations

• Administrative staff appreciate clear expectations,

increased efficiency and autonomy, and increased communication

Staffing for Success

Your outpatient program will likely need to engage the following team members.

Consider who will create the right environment and support your practice for success.

Key Considerations

The key to building a successful outpatient strategy starts with

standardization and planning for efficiency. Building the right

team, and setting expectations for team members, caregivers,

and patients along the way will set the whole team up for

success.

Investing up front in the right facilities, staff, community

outreach, educational and communication programs will also

be necessary for a successful outpatient program.

There are many important considerations when determining whether you are ready to open an ASC or expand your procedure offering.

Is outpatient surgery RIGHT FOR ME?

• Surgeon

• Surgeon Assistant

• Internist

• Medical Specialist

• Physical Therapist

• Anesthesiologist

• Social Services

• Total Joint Navigator

• CEO

• Supply Chain

• OR Manager

Care TeamAdministrative Team

Physician Preferences

Maximal efficiencies may be driven through preference standardization, however it is important to consider

the preferences of each physician that you will partner with.

Typical Options Include:

1. Freestanding ambulatory surgery center with joints and spine

2. Partnering with a hospital in a minority ownership within their outpatient facility

3. Retrofitting or adding a service line to an existing ambulatory surgery center

As you plan the space you will need, consider the following resources you may need:

Determine the type of facility and organizational structure your outpatient program will exist within.

Facility Considerations

• Large operating room

• Surgical table

• Sterilization capabilities to handle total joints

• Surgical equipment

• Storage

• Circulation

• Positioning equipment

• X-ray

• C-ARM/upgraded fluoroscopy

• Operating room equipment (specialized table)

• Computer navigation system

• Power system

• Supplies

• Adhesive drape

• Dressing wrap

• Drains

• Environmental control

• Hoods/headlights

• Warming blankets: IV fluid warmers

• Cement and accessories

• Continuous passive motion (CPM)

• Pulse lavage irrigator

• Tourniquets

• Backup equipment

• Power equipment

• Sutures

Capital Investment/Resources

Operating Room Supplies

Physician 1: (products, schedule preferences, etc) Physician 2: (products, schedule preferences, etc) Physician 3: (products, schedule preferences, etc)

MANAGEMENT SERVICES

MANAGEMENT SERVICES

Metrics and Operational Workflows

Getting a clear picture of what’s working and what isn’t is necessary to operate an agile facility with long-term success.

Consider which metrics will need to be tracked and the programs needed to

collect and track these.

• Financial requirements

• Projected length of stay

• CMS “never events”

• Re-admission rates

• Medical errors

• Community recognition and communication

• Ancillary consults

• Staff turnover or staff satisfaction

• Arrival/check in

• Care initiation

• Care delivery

• Care coordination

• Care assessment

• Departure/check-out

Setting your practice up for success starts before opening your doors or adding a new service line.

We can help you navigate market opportunities, negotiate reimbursement rates and get you started

with clinical pathways that are efficient and cost effective.

Get started with clinical pathways that are efficient and cost effective.

Our Care Management Services

• Market opportunity analysis

• Reimbursement negotiation

• Clinical workflow and efficiency consulting services

• Financing programs

• Co-marketing

MANAGEMENT SERVICES

Accelero Clinical Consulting Services

As a team of experienced clinical, process and business specialists, we focus on the orthopedic episode of care including patient outcomes and process efficiency.

We will help define the best outpatient joint replacement

program for you, focusing on effectiveness across the entire

episode of care.

MANAGEMENT SERVICES

ACCELERO CLINICAL CONSULTING SERVICES

PROGRAM INFRASTRUCTURE

CONSISTENT CARE

PROCESS

PROGRAM DOCUMENTS

DATA COLLECTION

PATIENT & CARE TEAM

WORKFLOW

PERIOPERATIVE WORKFLOW

PREOPERATIVE WORKFLOW

MANAGEMENT SERVICESMANAGEMENT SERVICES

Data CollectionIndicators • Measure Outcomes

We help institute the collection process for clinical, operational,

functional and patient satisfaction outcomes so you can

effectively manage your performance for long term success.

Program InfrastructureEstablish Program • Monitor Progress

Identifying roles and responsibilities for continuous process

improvement is critical for success. We will guide your

organization through a process improvement method that will

allow your program to continually progress.

Consistent Care ProcessOne Team & One Process

We will review all of the elements – from 30 days prior to 90 days

after surgery – to develop an effective and consistent delivery

model across the entire episode of care.

Program DocumentsCustomized to Support Consistency

Partnering with us gives you instant access to specialists who

can assist in customizing templates of documents that you will

need to implement your ASC program.

Our team facilitates the development of process tools

that intend to support the patient/staff education.

Patient & Care Team WorkflowEstablish Pathway • Define Roles & Responsibilities

This program provides educational content to fully prepare

patients for the surgery and post-surgery recovery.

Requirements are established for home care providers to

provide a consistent level of care. You will also receive a

set of post-discharge protocols that are crucial in the early

identification of potential complications.

Perioperative WorkflowOptimize Processes • Drive Efficiency

The success of many ASC based Outpatient Joint programs

has come down to managing the capacity through the

Perioperative environment. We will work along side you and

your staff to make the changes necessary for your ASC program

to be successful.

Preoperative WorkflowEnsuring you are able to align your program to payers and

demonstrate success is vital to a profitable ASC venture.

Our specialists will partner with your team to instill documented

tools and workflows that will instill confidence in your payer

partners. Our team can also aid in determining the ideal service

bundles for your facility.

MANAGEMENT SERVICES

World-Class Medical Education

We provide an interactive learning environment for advancing education and

training, providing personalized experiences that deliver results with the ultimate

goal of improved clinical outcomes.

Through the Surgeon-to-Surgeon visitation program, surgeons are paired with

Zimmer Biomet consultants at approved visitation sites across the United States to

review and observe specific surgical techniques, view live surgeries and discuss best

practices of operating in an ASC.

Financial Solutions

Our unique financial solutions are designed to empower you with the latest technology to advance care including:

• Committed contracts to access technology and services

• Innovative leasing and financial solutions

All of our options are available through our One Bill Program. This is a program designed to make billing throughout the entire

episode of care easier than ever. Whether you purchase technology, implants or capital equipment from Zimmer Biomet,

we have a streamlined solution to put it all on one bill.

Co-Marketing

The key to building a successful outpatient strategy

from billboard advertising to online advertising, we offer

a comprehensive direct-to-patient marketing program

with the goal of driving more patients to your ASC.

Supporting education of, and communication with, your patients, peers, and practice.

Medical Education, Marketing and Financial Programs

CARE OPTIMIZATION

Our Care OPTIMIZATION OFFERINGSmymobility®

mymobility helps your care team push instructions to patients and

allows you to track whether or not they are meeting their presurgical

requirements – minimizing cancelled surgeries.

Quantitative and qualitative assessment are gathered through the app

and provide both patients and care teams with increased insight to

inform their personalized care plan.

Improving care coordination at every step in the episode of care.

Efficient Care

Our Efficient Care program offer streamlined surgical trays to help:

• Minimize the number of instruments processed by the central sterile department and reduce associated sterilization costs.

• Streamline the case workflow and shorten room turnover – creating capacity for more cases.

Before Efficient Care

P OT E N T I A L F O R A

67% REDUCTION O F I N S T R U M E N T T R AY S1

4 FEWER TRAYS

+$58 TO PROCESS EACH TRAY

$232 SAVED PER CASE

After Efficient Care

Patients must have a compatible smart phone to utilize mymobility.All names used in this document are fictitious. No identification with actual patients or health care professionals is intended or should be inferred.

INTRA-OPERATIVE Technology

Guidance Technologies

Revision knee surgery is associated with total costs of $49,360.1

A nationwide report has shown that 8 years post-surgery, guidance

technologies like iASSIST® Knee showed 25% less revisions due to

loosening of the implant than the ones placed using conventional

instruments.3

Surgery Assisting Technology

INTR A-OPER ATIVE

WalterLorenz® Surgical Assist Arm

Personnel costs are the single biggest line item expense in a

multi-specialty surgery center.5 Walter Assist Arm is designed

to minimize personnel and clutter in the operative field.

A recent cadaveric study found ROSA Knee can improve surgeon accuracy by providing an intuitive user interface displaying planned resections throughout the cut flow and a validation tool to verify cuts’ accuracy in real-time.4

Please add that ROSA knee has not been clinically evaluated for reduced revision rates.

Infection Management

Bactisure™ Wound Lavage

A contributing factor to PJI is antimicrobial resistance, and biofilms

contribute to antimicrobial resistance. Bactisure Wound Lavage

effectively removes common wound pathogens including bacteria

found in biofilms and is backed by a 90-day warranty.8,9

The cost per Periprosthetic Joint Infection (PJI) treatment is $60,000-$100,000.6,7

INTR A-OPER ATIVE

Industry Leading Implants

Comprehensive Portfolio

Our comprehensive portfolio gives each surgeon the ability to tailor treatments for each patient in an efficient and cost effective way. Our

comprehensive portfolio of clinically proven implants, instruments and technologies are designed to help you preserve soft tissues when possible

and restore natural knee anatomy, motion and feel when total joint reconstruction is needed.

We are actively committed to providing each surgeon the ability to tailor treatments for their patients’ unique anatomies and conditions.

Personalized Knee Solutions

More than one in three10 knee replacements implanted around the world is a Zimmer Biomet product, making us a trusted source for quality knee

replacement products. Our full line of implants, instruments and technologies allow you to feel confident knowing you have the right tools to personalize

each procedure for each patient regardless of the unique challenges or conditions they present.

Preserve

JuggerStitch™ Meniscal Repair Device

AccuFill® BSM

Persona® Knee The Oxford® Partial Knee

Replace

INTR A-OPER ATIVE

INTR A-OPER ATIVE


Anterior Approach Hip Solutions

The Anterior Approach is gaining popularity in ASCs for good reason. Patients may experience faster recovery with less pain11,12 and go home sooner13

than patients treated with the posterior approach, making it an ideal procedure for ASCs where patients reportedly return home more quickly.

We offer dedicated instrumentation, implants and medical education to help you implement anterior hips in your ASC.

We are actively committed to providingeach surgeon the ability to tailortreatments for their patients’ uniqueanatomies and conditions.

Avenir Complete™

INTR A-OPER ATIVE

Shoulder Solutions

Zimmer Biomet offers a complete array of shoulder replacement systems and associated products.

As well as being optimized for each patient’s unique anatomy, all of our shoulder systems address key needs

to help surgeons restore kinetics and range of motion to their patients.

Preserve

Replace


BioWick® Implants Interpositional Scaffold-Anchor Implants

Ventix™ Link Screw-In Knotless Anchors

Comprehensive® Reverse Shoulder System

JuggerKnot® All Suture Anchors

Sidus® Stem Free Shoulder


INTR A-OPER ATIVE

Foot and Ankle

Our Foot and Ankle products focus on providing the latest treatment options for the midfoot, forefoot, hindfoot, and ankle.


Replace

Zimmer Biomet Trabecular Metal™ Total Ankle

Stratum™ Foot Plating System

ZipTight™ Ankle Fixation System

Preserve


Stratum is a trademark of Nextremity Solutions, Inc.

POST-OPER ATIVE

POST-OPERATIVE Technology

One study found that 5.81% of patients made unplanned ER visits following total joint arthroplasty. The total cost associated with unplanned ER visits were $15,427 - adding significant costs to the care episode.14

The direct messaging feature of mymobility with Apple Watch allows the patient

to communicate with the care team with the intent to reduce unnecessary visits

to the ER and intervene at the appropriate time with education.

This helps your care staff by:

• Reducing time spent making phone calls

And is intended to help patients by:

• Encouraging patient compliance

• Minimizing unnecessary ER visits

Patients must have a compatible smart phone to utilize mymobility Apple Watch and iPhone are registered trademarks of Apple, Inc.

POST-OPER ATIVE

POST-OPERATIVE Technology

One study found that only 35% of patients are compliant with their physical therapy protocol.13

Video-guided exercises and activity tracking allow both patients and the care

team to stay in-sync throughout the continuum of care. Via remote monitoring,

mymobility tracks compliance and identifies patients that need further assistance

in-real time, allowing care teams to intervene. Self-directed exercise programs are

designed to reduce the patients’ out-of-pocket physical therapy and encourage

the patient to complete the personalized care plan.

The following factors may be considered prior to scheduling surgery

in an ASC, as they may affect the efficiency of your operating day,

or be risk factors for complications.

• Motivated patient

• Healthy status with no major co-morbidities (see exclusion criteria below)

• Living situation (stairs; walk-in shower vs tub; proximity to outpatient rehab)

• Consider social factors when identifying a patient candidate for outpatient surgery

• Living space (number of stairs to get into the home)

• Orthopedic condition severity

• Insurance

• Difficulty of the case

• Other ailments that may affect rehab

• Support mechanisms (healthy supportive spouse or friends)

Pre-operative Outpatient Considerations

Not all patients are candidates for outpatient surgery. Here are some considerations when finding patients who can be successful with at-home recovery.

CONSIDER ATION FOR ASC’s

PRE-OPERATIVE Outpatient Considerations

Patient Education

Creating and rolling out a robust patient education program should

include the following elements

• Determine the delivery method for patient education: via mobile devices, a classroom experience, or a written manual provided one month prior to surgery

• Review the type of anesthesia that will be used, and recovery expectations

• Review pre-operative exercises and physical therapy consultation expectations

• Conduct pre-operative education program through determined delivery method

• Create a patient contract verifying compliance to the pre and post operative protocols

• Create communication pathways including reminders for appointments and feedback on progress post-operatively

• Discuss length of stay (LOS) expectations

• Create plans for discharge to home

• Prescription medication as needed for: Anxiety, hypertension, hypotension, itching, insomnia, nausea/vomiting, pain relief

• Medical exams: chest x-ray, blood work, EKG, pre-operative lab tests, list of current medications

• Schedule patient history and physical ~2 weeks prior to surgery

• Schedule post-operative appointments

• Create standard order sets

• Anticoagulation

• Wound care and dressings

• Pain medication protocol

• Physical and occupational therapy goals (needed?)

• Patient to identify physical therapy location and skilled nursing facility (if needed)

Patient education and expectation setting prior to surgery plays a role in patient satisfaction postoperatively.


PRE-OPERATIVE Outpatient Considerations

Patient education and expectation setting prior to surgery plays a role in patient satisfaction postoperatively.

Day of Surgery Checklist• Intravenous fluids

• Pre-operative labs completed

• Urinary catheter

• Pain assessment at regular intervals

• Surgeon visitation

• Nurse care protocols initiated

• Patient is NPO; intravenous fluids continued; Is and Os monitored

• Pain assessments

• Standardized pain regimen

• Bowel regimen

• Antiemetic prn regimen

• Brochure/handout discussing care given for patient and family

Anesthesia Checklist• Determine regional or general anesthesia

• On call for pain management issues


PERI-OPERATIVE

Pre-Surgical• Surgical scheduling for optimal flow day of surgery

• Weekly patient review to anticipate and prepare for efficient patient and material flow

Day of Surgery• Patient flow plan from arrival through PACU

• Room setup training and plan

• Room turnover training and plan

• SPD

• Instrument and tray reduction

• Capacity planning

• Staff training

• Metrics gathering and review

• Bowel regimen

• Wound care


POST-OPERATIVE Considerations

The patient recovery process starts as soon as surgery ends. Here are some important things to think about in your postoperative care protocol.

Post-Operative Considerations• Standardized pain treatment regimen

• Anticoagulation

• Urinary catheter removal

• Is and Os measured and recorded to assess fluid balance

• Saturation monitored

• Turn, cough, and deep breaths

• Patient started on clear liquids

• Activity bed to chair

• Bowel regimen

• Wound care


REFERENCES

1. Persona Instrument Tray Reduction Memo

2. Bhandari M, Smith J, Miller LE, Block JE. Clinical and economic burden of revision knee arthroplasty. Clin Med Insights Arthritis Musculoskelet Disord. 2012;5:89–94. doi:10.4137/CMAMD.S10859

3. de Steiger R. The Outcome of Computer Navigation for Primary Knee Replacement. AOA. 2013.

4. Parratte, S., et al. Accuracy of New Robotically-assisted Technique for Total Knee Arthroplasty: A Cadaveric Study. The Journal of Arthroplasty. 34(11): 2799-2803, 2019.

5. Staffing: Understanding a surgery center’s biggest expense. Merritt Health Advisors. 2017. https://merrittadvisory.com/staffing-understanding-surgery-centers-biggest-expense

6. Gutowski, C. J., et al. The Incidence and Socioeconomic Impact of Periprosthetic Joint Infection: United States Perspective.

7. Kendoff, D. et al. (eds). Periprosthetic Joint Infections: Changing Paradigms. Springer International Publishing Switzerland, 2016.

8. Antimicrobial Test Labs, Inc. study GLP1175.

9. Dr. Garth James, Montana State University Center for Biofilm Education; Next Science report TR-02-14-010.

10. CRT Initiating Coverage of the Orthopedic Medical Technology Industry. Industry Report. November 3, 2015.

11. Miller LE, Kamath AF, Boettner F, Bhattacharyya SK. In-hospital outcomes with anterior versus posterior approaches in total hip arthroplasty: meta-analysis of randomized controlled trials. J Pain Res. 2018;11:1327–1334.

12. Miller LE, Gondusky JS, Bhattacharyya S, Kamath AF, Boettner F, Wright J. Does surgical approach affect outcomes in total hip arthroplasty through 90 days of follow-up? A systematic review with meta-analysis. J Arthroplasty. 2018;33(4):1296–1302.

13. Kyriakopoulos, G., Poultsides, L., Christofilopoulous, P., Total hip arthroplasty through an anterior approach: the pros and cons. Efort Open Reviews. 2018; 3: 574-583.

14. Sibia, US, et al. Incidence, Risk Factors, and Costs for Hospital Returns After Total Joint Arthroplasties. J Arthroplasty. 2017 Feb;32(2):381-385

15. Sluijs, E., et al. Correlates of exercise compliance in physical therapy. Phys Ther. 1993 Nov;73(11):771-82; discussion 783-6.

2945.1-US-en REV0120

The Oxford Partial Knee is intended for patients with osteoarthritis or avascular necrosis limited to the medial knee compartment and is to be implanted with bone cement.The Oxford Knee is not indicated for use in the lateral compartment or for patients with ligament deficiency. Potential risks include, but are not limited to, loosening, dislocation, fracture, wear, and infection, any of which can require additional surgery. For complete prescribing information, see the package insert and www.zimmerbiomet.com.

This material is intended for health care professionals. For indications, contraindications, warnings, precautions, potential adverse effects and patient counseling information, see the package insert or contact your local representative; visit www.zimmerbiomet.com for additional product information. All content herein is protected by copyright, trademarks and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet. ©2020 Zimmer Biomet.