Becker's ASC Review

78 ORTHOPEDICS Tennessee orthopedic practice files for bankruptcy: 3 details By Alan Condon S pecialty Orthopedic Group Tennessee in Lebanon has filed for voluntary Chapter 11 bankruptcy protection, which allows businesses to restructure debts to help repay creditors over time, the Nashville Business Journal reported March 11. Three details: 1. The practice listed assets of zero and debts up to $286,993. 2. With an outstanding claim of $204,000, First Citizens National Bank was named as the group's largest creditor. 3. The practice filed for bankruptcy Feb. 24, and bank- ruptcy courts recorded the filing in early March. n The market will 'continue to evolve': An ASC administrator's outlook on payers and orthopedics By Carly Behm R aghu Reddy, administrator at Cumberland-based SurgCenter of Western Maryland, spoke to Becker's ASC Review about payers' evolving attitudes toward spine and orthopedic surgery. Note: Responses are lightly edited for style and clarity. Question: How have payer attitudes toward total joints and spinal fusions changed? Raghu Reddy: When we started negotiating with our commercial payers, it all came down to the value proposition, the quality scores and outcomes. So we were able to prove to most of our commercial carriers the cost sav- ings that they're going to realize by shiing all the eligible and healthy outpatient joints to our surgery center. One other advantage we had is that we were the only surgery center in the area. So they really helped us with a contract negotiation. We had a one-hospital system, so shiing those healthy joints to the surgery center did prove a tremendous amount of value-add cost savings to the com- mercial payers. at really worked out in our favor, and we're able to negotiate a favorable contract and since then their attitude has been great. We never had real issues with reimbursement or any of the billing issues when it comes to some of these bigger cases. Q: Do you expect any changes from private payers in the next one to five years? RR: ere is a lot of data that's coming out these days in terms of different specialties. e private payers used to piggyback on the Medicare approval or what Medicare was do- ing, but now they're really starting to branch out and take things into their own hands and doing their own studies and looking at the data to approve some of these complex proce- dures, even before Medicare removes it from the inpatient only list. at trend will con- tinue to evolve. ere might be some bundled payment-type agreements that might come out in the future with some of the commercial payers sooner than Medicare. We were able to do some single-case agreements with some of the payers, but I would not say it was all in all, that's the standard across the board. e ASC market is going to continue to evolve. But, when it comes to reimbursement — some of the other payment models and improving the outcomes and creating the overall value for both the payer and the patient, that's going to continue to evolve. Q: Are you considering any types of value-based payments, or is it still all fee-for-service? RR: Well, we've been predominantly on fee-for-service historically from the outpa- tient surgery standpoint. We have not been approached by any payer yet in terms of a value-based approach or any bundled pay- ment, but I'm sure as the market evolves it may continue to lead into the future. at's going to be on the horizon. I know as of last year CMS has completed a common review on the Comprehensive Care for Joint Replacement Model. One of the things that is important to realize is the finan- cial burden that a center bears if we were to elect or be forced into this bundled payment. So for example, in rural areas, our reimburse- ment is almost all much lower compared to some of the urban areas. Administrators should think about how much cost savings are we going to realize in the 90 day period by going into this bundled payment-type sce- nario or other other payment models. at's something that is going to be very subjective. I'm very anxious to know if and when this is going to come and if it's going to be manda- tory or elective, and we can go from there. n Rhode Island orthopedic practice opens $33M facility By Carly Behm P rovidence-based Ortho Rhode Island opened a new $33 million facility, according to a March 25 report from the Warwick Beacon. Four details: 1. The new facility will house Ortho RI's Warwick and East Greenwich offices. 2. The facility is 66,000 square feet and has three floors. 3. The third floor has an outpatient surgery center with eight operating rooms, and the first two floors have ortho- pedic, imaging and physical therapy services. 4. The facility was completed on time despite the CO- VID-19 pandemic. It broke ground in April 2019. n

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