Becker's ASC Review

26 ORTHOPEDICS Stryker says nearly 10% of its knee business is in ASCs By Laura Dyrda A SCs comprised nearly 10 percent of Stryker's knee business last year, and the company expects the move of orthopedic surgeries to the outpatient setting will continue. "As we think about our focus from our offense standpoint, as we think about the ASC, we are seeing the shi [outpatient] happen across our product line," said Preston Wells, Stryker's vice president of investor relations, during the company's 2021 earnings call Jan. 27, as transcribed by Seeking Alpha. "We expect that to continue to grow. ere is an opportunity for [ASC business] to continue to grow over time. Certainly there are capacity constraints as ASCs are built out that will allow it to con- tinue to grow faster." He said the timeline for expanding the company's ASC business would depend on how quickly surgery centers are able to grow joint replacement volume so surgeons can take their cases from hospitals to ASCs. "We are here and actually helping to make that transition happen," he said. e pandemic continued to affect Stryker's business, but the company was still able to surpass $17 billion in revenue last year, and Kevin Lobo, Stryker's chair and CEO, said he is confident in the company's outlook over the next year. "We continue to execute on our key growth strategies, including the expansion of our ASC offense, continued product innovation and category leadership across our busi- ness," he said. Stryker's Mako robotic joint replacement technology continues to thrive, with about 1,500 robots placed. ere were 27 percent more robots installed in 2021 than in 2020. "e strong double-digit growth also under- scores our ongoing success installing robots in major teaching institutions, ASCs and competitive accounts, as well as our focus on expanding into international markets," said Mr. Wells. "In the fourth quarter, we saw a meaningful increase in the percent- age of robots installed into competitive accounts." n Florida ASC sues Cigna for $434K spine reimbursement By Marcus Robertson M elbourne, Fla.-based Surgery Center of Viera filed a lawsuit Jan. 20 in Florida Middle District Court in Orlando against Cigna and Strategic Enterprise Solutions. The ASC is seeking $434,000 for reimbursement of spinal surgery to treat a patient with "chronic (and progressively worsening) debilitating back pain," according to court documents. The center alleges Cigna determined the surgery medically necessary but only reimbursed about $75,000 on a billed amount of $405,373. Surgery Center of Viera said Cigna allegedly used a "mystery re-pricing program" in calculat- ing the reimbursement amount, rather than a previously established re-pricing contract the center says should have resulted in an 80 per- cent reimbursement rate, or $350,693. The ASC also alleges Cigna shirked a legal responsibility to produce applicable records related to the reimbursement and its calculation. If true, the center said Cigna would be on the hook for a $110 per day penalty from the federal government beginning Feb. 12, 2018, totaling $158,180 as of Jan. 20, when the lawsuit was filed. n Reimbursement for total joints, spine and big ENT cases to go up, ASC admin says By Marcus Robertson C ori Prisco, DNP, RN, administrator at Fort Lee, N.J.-based Hudson Crossing Surgery Center, joined "Becker's Ambula- tory Surgery Centers Podcast" to discuss ASC payer trends in the near future. Note: This is an edited excerpt. Question: How do you see some of the payer trends and con- tracting changing in the next few years? Dr. Cori Prisco: I see us being able to use the data we have to show the payers that this just makes sense. We provide value, we provide efficiency. A lot more procedures are going to be brought to the outpatient setting than we've ever seen before, because we're able to contain costs, and payers are going to see that. We're going to be able to negotiate better rates for some of these larger procedures, like the total joints, bigger ENT cases and spine cases. Centers that aren't doing these cases are looking to expand their programs because the payers are starting to pay for them, and they're starting to pay well for them. At the same time, we have to make sure we're verifying benefits and making sure this new technology is all going to be covered so we can still contain costs. And then I think we're seeing more employer direct healthcare plans emerging. So I think individually, surgery centers are going to be negotiating directly with more of these plans. n

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