Becker's Spine Review

57 ASC Opening an ASC? Here's what spine surgeons need to know By Alan Condon T he migration of higher-acuity spine surgeries to the outpatient setting presents an opportunity for stakeholders and surgeons to realize significant profit in the coming years if that ASC is operated properly. Currently, there are more than 180 ASCs that perform minimally invasive spine sur- gery in the U.S., with more spine-focused surgery centers expected to open. Market growth will be driven by the effects of the COVID-19 pandemic, the need to cut health- care costs and physicians' desire to control the surgical environment. Here are three key items spine surgeons should know about opening an ASC: 1. Choose the right physician partners. e first and most important aspect of opening an ASC, according to Kern Singh, MD, of Chicago-based Midwest Orthopaedics at Rush, is the right partners who you trust will dedicate the time and resources into making the surgery center a success. Central to the success of any surgery center is a core group of physicians who are committed both financially through an investment and to performing cases at the ASC. "Many people will want to be a part of the ASC once it's established, but the true value in your partners is when they start the center with you and help you deal with the growing pains," Dr. Singh told Becker's. 2. Decide on a management team/company. Once you've got the right physician partners on board, the second step is finding the right management team, such as "venture capital firms and existing big ASC players who have reliably demonstrated the necessary traits for succeeding," according to Brian Gantwerker, MD, of Craniospinal Center of Los Angeles. Employed surgeons understand the complexities, turnover times and delays that are common in hospital operating rooms. Such issues, oen "written off as de rigueur at the hospital, will lead to a failed ASC," Dr. Gantwerker said. e management team is "almost as important as the partners you open the ASC with," Dr. Singh said. "[ey] help make critical decisions, including payer contracting, im- plant negotiations and hiring of essential personnel, including the director of nursing and surgical staff, which can make or break the efficiency of the center." 3. Identify an anesthesia group. Another key component of establishing a successful ASC with great outcomes is find- ing the right anesthesia group to help run the center. "An anesthesia group well-versed in contemporary multimodal analgesia and outpa- tient spine and total joint arthroplasty is essential for the center to accommodate the increasing number of historically inpatient volumes that have now migrated to the ASC space," Dr. Singh said. It's also vital to ensure real estate costs and personnel expenses are in line with the payer reimbursements, "otherwise centers can be inundated with debt and may take many years to generate a successful return on investment," Dr. Singh added. e outpatient market is expanding rapidly, and owning and operating an ASC is a viable option for spine surgeons. Opening an ASC is no easy feat, but the reward can be worth the initial risk if stakeholders do their due diligence in the planning and de- velopment stages. n UnitedHealth Group's plan to drive more surgeries to ASCs By Laura Dyrda U nitedHealth Group made three long-term commitments as part of its sustainability efforts, includ- ing pushing more surgeries to ASCs, according to a June 15 company report. UnitedHealth Group aims to have more than 55 percent of its members' outpa- tient surgeries and radiology services delivered at high quality, cost-efficient sites of care by 2030, which often means directing patients to ASCs. In 2019, the company reported 47 percent of outpa- tient surgeries and radiology services were performed at high quality, cost-ef- fective settings. UnitedHealth Group said it aims to meet its goal by: • Providing physicians with point-of-care tools for shared decision-making about care delivery • Guiding patients to low-cost care set- tings • Developing digital tools for members to identify care sites that meet quality and cost standards Conducting more joint replacements in ASCs for commercially insured patients could save $20 billion in the next decade and lead to 500,000 fewer hospitalizations per year, the report stated. And shifting diagnostic tests from the hospital outpatient department to physician offices or standalone centers could save members $300 per test and lower spending by 62 percent, accord- ing to the report. OptumCare, the division of UnitedHealth Group's Optum that provides physician services, has 53,000 employed and aligned physicians who treat 20 million patients annually. UnitedHealth Group also said it's com- mitted to closing 600 million gaps in care for members by the end of 2025 and en- suring 85 percent of members receive preventive care annually by 2030. n

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