Becker's ASC Review

18 Thought Leadership 4 major obstacles for the ASC industry By Patsy Newitt A ndrew Lovewell, administrator at the Surgical Center at Columbia (Mo.) Orthopaedic Group and CEO of the Lodge at Keene Street, joined Becker's ASC Review to discuss his biggest concerns in the upcoming year. Editor's note: is interview was edited lightly for brevity and clarity. Andrew Lovewell: e biggest thing that concerns me is probably the same thing many of my ASC colleagues are concerned about. ey consist of governmental overreach, the ongoing COVID-19 pandemic, staffing short- ages and patient safety. With vaccine mandates from CMS being upheld in many states by the Supreme Court, I have a huge concern about retraining staff and assuring that I can provide the best care to my patients. All our staff are tired from the pandemic and adding another layer of complexity with vaccine mandates doesn't do us any favors. I know, like many ASCs, we have excellent staff that do a great job with our patients and physicians, and if they continue to be bombarded with more strenuous federal requirements, we will un- doubtedly lose some of them. Tying into governmental involvement, I am extremely concerned about removal of codes from the ASC-approved list and the announcement that the inpatient-only list is here to stay. e focus of value-based care is to lower cost and provide high(er) outcomes. If we are keeping cases in an inpatient facility where there are several COVID-19 positive patients and adding cost to the procedure, I see value-based care taking the back seat in this approach. Taking this nonprogressive stance is one thing, but continuing to see a large gap between hospital outpatient depart- ment rates and ASC rates is equally a concern. In today's world, we see ourselves at a cross- road. We want to provide high quality cost- effective care to patients, and we strive to be a value-based provider, but the external pres- sures are becoming daunting. At some point in time, we will find ourselves in a dire position if these trends continue. In some regard, I think many people think it's an us (ASCs) vs. them (hospitals) battle. But in all reality, we are ALL fighting to retain staff, do the best we can for our patients and survive these trying times. n MSOs vs. PE: How consolidation trends will play out in orthopedics By Alan Condon M usculoskeletal management services organizations and private equity firms continue to make inroads into the orthopedic field as small to midsize independent groups look for strategic partnerships to allow them to grow and maintain their autonomy. Two spine surgeons discuss the ups and downs of these consolidation models and how they see them playing out in the orthopedic field. Editor's note: Responses were lightly edited for style and clarity. Question: How do you anticipate management service organizations and private equity groups affecting consoli- dation among orthopedic practices in the coming years? Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Of all the things that result in the curtailing of physician independence, MSOs offer the best hybrid model. When it comes to offloading overhead while letting the surgeon or group be "themselves," it allows for growth, cost containment and very likely the most job satisfaction compromise. Private equity, as we have seen entering this space, is not good for patient care. The corporate practice of medicine is not the solution to what ails our system. Patients over profits should always be the physician's mantra. While it is tantalizing to partner up, go to expensive lunches, and sign lucrative deals, it is not worth the sacrifice of autonomy and very likely, selling the soul of your business. By the time one realizes patients are not getting the same quality of care one would customarily give, it will be too late to change. This, I fear, will be the endgame of our system. Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): In recent years, high-acuity surgeries, includ- ing both spine and orthopedic cases such as total joint replacement and shoulder reconstruction, have migrated from the inpatient to the outpatient environment. This trend is progressing quite rapidly. Private equity groups have taken the opportunity to help control this migration by investing as financial supporters and capitalizing on the opportunity. To do so, they are instituting significant business input and quality control as this transition takes place. The goal is to develop a more cost-effective outpatient world that can handle the shifting insurance market and position it for managed care in its ultimate version. You can look to the MSOs integrating multiple centers together via either pur- chase or management to accomplish this goal. n

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