Becker's ASC Review

20 Thought Leadership What procedures are migrating to ASCs? By Patsy Newitt C OVID-19 has accelerated the migration of surgeries to the outpatient setting, and many administrators expect the trend to continue. Six administrators spoke to Becker's ASC Review on the procedures they see moving to the ASC setting. Complex spine procedures Administrators are seeing three-level 360-de- gree fusions, anterior cervical discectomy and fusions, spinal cord neurostimulation, periph- eral nerve neurostimulation, and interspinous process decompression shiing to ASCs. Nate Garner. Administrator of Fort Sutter Surgery Center (Sacramento, Calif.): Spine surgeons have been performing outpatient spine surgeries such as spinal fusion and disc decompression surgery in ASCs for years now. However, there has recently been an explosion in the minimally invasive spine arena, and new products and techniques have been developed that have been implemented in the ASCs. Angela Laux. Nurse Administrator for Advance Spine Center of Wisconsin (Neenah): We had shown that single- and two-level cases of [360-degree fusions] could successfully be done in our ASC with excellent patient outcomes and satisfaction. Our surgeons see the value to the patient having these cases done here. Gastroenterology procedures Eugenio Hernandez, MD. Vice President of Clinical Affairs for Gastro Health (Mi- ami): Endoscopic ultrasounds with [fine- needle aspiration] or biopsy can be performed safely in ASCs. We have been performing EUS at several of our ASCs, including EUS- directed liver biopsy. ere are operational considerations that must be accounted for, but studies have shown that the incidence of adverse events in the outpatient setting is similar to that in hospital endoscopy units. While there have been studies published dem- onstrating that [endoscopic retrograde chol- angiopancreatography] can also be performed safely in an ASC setting, this would require a highly selective policy that would limit the volume of potential procedures, impacting the financial feasibility of performing ERCP in the ASC setting. Total joint procedures Mr. Garner: Total joint replacement surgeries have been performed in ASCs for several years now. Initially these patients may have been kept overnight to ensure a smooth recovery, but now more oen than not, are being discharged home the same day. Medicare currently covers total knee and total hip replacements. Other total joint procedures being successfully performed in the ASC include total shoulder, ankle and elbow arthroplasty. Teresa Copeland, the director of managed care for Knoxville-based OrthoTennes- see, told Becker's ASC Review that total joint replacements have been the biggest movement over the past 18 months. Her facility is on track for over 1,200 total joints in 2021. Robotic procedures Mr. Garner: As technologies improve and space and affordability barriers are addressed, it is likely that we will see robotic-assisted surgery become more common in the ASC for various other procedures including hernia repair, cholecystectomy, hysterectomy, prosta- tectomy, bronchoscopy and spine surgery. Cardiology procedures Mr. Garner: Positive outcomes, improved patient experience and cost effectiveness have driven this focused shi in expansion of cardiovascular services to the outpatient setting. Included in the list of cardiac procedures now being performed in ASCs in states where permissible are angioplasties, catheterizations, pacemaker insertion and loop recorder placement. Brock Kreienbrink, MSN, RN. Administrator and Director of Nursing for the Outpatient Surgery Center of Central Florida (Wildwood): Since I am a cardiac- only surgery center, my main focus is on car- diology, and I see a huge push of cardiologists opening their own surgery centers. With the [Medicare] approval of coronary atherectomy and percutaneous coronary intervention, you should see a huge push from cardiology into surgery centers. David Horace, the administrator and owner of Bel-Clair Surgical Center in Belleville, Ill., told Becker's ASC Review that he sees select electrophysiology procedures making the move to surgery centers because of com- mercial insurance company interest. n Former ASC administrator named CEO of physician-owned USPI hospital By Patsy Newitt United Surgical Partners International affiliate TOPS Surgical Specialty Hospital in Houston has named Grant Magness CEO, Community Impact reported May 4. Mr. Magness previously served as the administrator of Memorial Hermann Sur- gery Center Greater Heights and Memorial Hermann Endoscopy Center North Loop, both in Houston and USPI affiliates. He also previously served as CEO for a transitioning hospital in Yakima, Wash., according to Community Impact. TOPS Surgical Specialty Hospital offers services including ear, nose and throat; gastroenterology; general surgery; orthopedics; pain management; and spine surgery. n

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