After a couple of weeks we decided that we were going to cut the surgery center in half. Instead of a 4 room surgery center, we would do 2 rooms. As a result, that left 4,500 sq. ft. of what we call ‘gray shell,’ which means it wasn’t finished. And every day, I would walk past that for about two years. Finally, at the same time, my orthopaedic practice was back on fire again. Joint replacements were changing dramatically in our community. Patients were no longer 70 or 75 years old. They were in their 40’s, hip replacements especially. I noted a bit of a crisis back then where it seemed like hip replacements were 40, 50 and 60 years old. And the same with knee replacements. My 55 year old guys and gals, my outdoorsmen, were becoming more popular. As a result of that, these were healthier patients that I wasn’t sure they needed to be in the hospital any longer. At the same time, you might remember 10 years ago or so, MRSA, infections and falls and complications were being duly noted in our town here of Las Vegas and Henderson.

As a result of walking past this 4,500 sq. ft. every day, I thought to myself, what if we put 6 really high end hotel-like rooms in this Center? What if these total joint replacement patients that were younger and healthier? What if they could have surgery in my Surgery Center? And then after the surgery was over, maybe they could stay in ‘my house’ as opposed to going to ‘their house.’ So we didn’t need a medical facility. We needed basically a place to take care of them. Just as if we were going into their home. Well in 2010, that all came to fruition because I went and I built the six rooms. Borrowed the last bit of money probably a bank was loaning anybody at that point and we built the six rooms. The one thing we forgot was how to pay for it.

Outpatient joint replacement was not a mainstay in orthopaedics and certainly in the reimbursement from commercial payers for Medicare, for that matter. As a result, I went out to the insurance companies and developed what’s called a ‘bundled rate.’ Bundled rates were becoming popular in Medicare, however, they just weren’t apparent in the commercial payer arena. Therefore, I sat down and started taking the Medical Directors and contracting personnel and developing real relationships with the hand that feeds us, our payers. That relationship turned out and still is to this day is fantastic!

We put together a bundled rate which would include the Surgery Center, the surgeon, the Recovery Suites and all it’s amenities for food and nursing and all the personnel and the therapist to take care of everyone. That would include the anesthesiologist in this as well and of course a top-of-the-rack implant because these patients were so young, we had to have the best implants for them.

Well, we are now fast forwarding about 10 years later. We’re 2,500 patients we’ve completed. We’ve nearly eliminated all complications and the Recovery Suites model has become what it is today. Bundled rates are becoming more popular among insurance companies and I think our 2,500 patients, the reporting, the patient satisfaction, net promoter scores, everything just simply being top-of-the-rack has changed the outpatient joint replacement arena.

So in retrospect, I guess I’m pretty glad the bank was taken over by the government – and who says that? But 10 years later, I couldn’t be happier.