Becker's ASC Review

21 Thought Leadership The big opportunities for ASCs today: 2 physician perspectives By Laura Dyrda O ver the past several months, ASCs across the U.S. experienced tempo- rary closures or case drops and then recovery during the pandemic. COVID-19 threw a wrench into the strategic growth plans for many physician groups in the ASCs, but there are silver linings as more patients, payers and physicians recognize out- patient surgery centers as the most desirable setting for quality care. During the Becker's ASC Virtual Event on Sept. 30, Frank Phillips, MD, co-director of spine surgery at Rush Uni- versity Medical Center in Chicago, and T.K. Miller, MD, vice chairman of the department of orthopedic surgery at Roanoke, Va.-based Carilion Clinic, discussed the big challenges and opportunities for ASCs moving forward. Question: What is your outlook for orthopedics and ASCs today? What do you think are bright spots and what are dark spots? Dr. Frank Phillips: It's an interesting time for ASCs, and we've all talked about how the COVID situation has really accelerated and driven demand to the ASCs. I think that fairly routinely patients actually now will request to have their surgeries done in ASCs rather than the quote unquote 'COVID' hospitals. I think there's a lot of demand for patients to stay out of hospitals, which they perceive as potentially risky, whether that's true or not. ere's a real awareness and demand among patients. In terms of what are the dark spots, for me as a spine surgeon, we're still chal- lenged by insurance issues. Some of the procedures we do have evolved and morphed toward ASC procedures or lumbar fusions, for example, which involve a lot of hardware and biologics and are generally expensive proce- dures. With covered reimbursement, those are oen not sustainable in an ASC environment, so I think that's sort of the dark spot. As the ASC-for-spine experience grows, I think we need to work through some of the road- blocks. To me, it's a no-brainer if you were the insurance company. You're getting the site of surgery that's being shown to be safe, the ASC, for a third of the price. What's not to like? at is where things are at least from a spine lens and some of the biggest challenges we face. Q: What are the challenges that you see, as well as the opportunities? Dr. T.K. Miller: I think the opportunities are straightforward. ere is a broad spectrum of cases that traditionally have been locked into a hospital environment. I think that the changes in the next two years with the CMS changes to the ASC payable list, we'll push that even further. I would agree that there's a disconnect between facility compensation and the cost of doing a number of the cases that are very appropriately done in that environment. We've gone back and have looked at cases to move over with commer- cial insurers, and we're still struggling to move cases for which there's no reason from a clinical standpoint, from an outcome standpoint and from a cost standpoint not to move. I'll use a simple one. Shoulder arthroplasty is possible in a freestanding ASC environment, but we still run into the challenge of you can't make money by volume. If you lose money on every case, it's not viable in the ASC. I think that's going to be the biggest challenge moving forward is a realistic expectation of what it costs to do a case and an appropriate reim- bursement in a non-hospital environment. n ASCs in 2021: 3 expert predictions about robotics By Carly Behm Three leaders shared their predictions for robotics in ASCs over the next 12 months with Becker's ASC Review. Note: Responses were edited for style and length. Meredith Warf, administrator at Mississippi Sports Medicine and Orthopaedic Center (Jackson): Computer- assisted navigation for joint replacement quickly became the standard of care. We've seen robotics slowly come onto the scene with barriers such as increased disposable cost required, advanced imaging studies needed and the sheer monstrosity of the machines in the operating rooms. The new robots today are as small as computer-assisted devices and are able to be performed with plain film X-rays as well as lower disposable costs. With the added surgery and quality data that can be gained through the robotic platform and integrated into our patient-reported outcomes pathway, we believe this invaluable piece of the puzzle will be helpful in planning the best care even before walking into the OR in the future. Raghu Reddy, administrator at SurgCenter of Western Maryland (Cumberland): The role of robotics will continue to evolve in the coming years in the ASC space. The very word "robotics" will bring capital investment costs to the forefront of decision-making. Currently, there is not a lot of evidence prov- ing that robotics significantly improves clinical results, especial- ly in orthopedics, where some ASCs are adopting robotics. We could see the competitive advantage the robotics bring to an ASC, but the thing to keep in mind is the reimbursement from the payers to cover the entire capital and maintenance costs of the robotic program in the ASC. We should continue to study the evolving clinical evidence for the outcomes before a justification can be made to include robotics and the footprint needed to accommodate this program. Taylor Cera, COO at Orthopaedic Surgery Center (Youngstown, Ohio): In orthopedics, the obvious question is at your own facility, what's the return on investment on the technology? Globally, it's here, and it's not going anywhere. Younger physicians are being trained on the technology, they see value in it, and they are going to want to use it. Patients are asking about it. Traditionally, I think patients just went to their same surgeon for most all [musculoskeletal] injuries. We are seeing a trend that patients are seeking out surgeons that use robotics for total joint surgery. n

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