Becker's ASC Review

41 THOUGHT LEADERSHIP so we must all continue to find opportunities to innovate, invest and collaborate in areas that support quality of care — knowing that best care will also work out in the end. e journey toward addressing pandemic-related losses will be a marathon — and you never want to start that race in a full sprint. Kenneth Nwosu, MD. Spine surgeon at NeoSpine (Burien and Puyallup, Wash.): My biggest industry concern is the ever increasing barriers by payers to provide high value care to our most vulnerable patients in a timely fashion. Over time, it appears that the default decision for procedures needing prior authorization is a denial, as indicated by a rising number of peer-to-peer reviews where the reviewing physician openly states that the ordered surgery should not have been denied. Alternatively, I am seeing more denials where a peer-to-peer review time is dictated by the payer, which is oen in conflict with the treating physician's availability. In some instances, there is not an option to partake in a peer-to-peer review following a denial. ese increasing denials have had a net negative impact on patients' health and are more burdensome to the healthcare and economic system (directly and indirectly) as a result of patients not receiving appropriate treatment in a timely fashion. e issue is further exacerbating the high burnout rates being experienced by surgeons and their staff. I believe this is the primary contributor to the sentiments expressed by many of my colleagues regarding leaving the field altogether. Continuing down this trajectory will likely contribute to further corporatization of healthcare, reduced competition, increased costs and ultimately reduce the value of healthcare that we provide. Issada ongtrangan, MD. Spine surgeon at Microspine (Scottsdale, Ariz.): My biggest concerns are: 1. e CMS pay cut in the time that we just came out of the COVID-19 pandemic, making it harder financially, especially with an independent practitioner. I have to find strategies to cope with this pay cut while maintaining the quality of care. Not to mention how many hours physicians have to spend to comply with the rules and regulations. 2. e pre-authorization process has been more difficult and consumes so much time. My biggest concern is that this will delay the patients' care. Every one of us who deals with it is so frustrated with this process. Many times, the wait time to talk to someone was ridiculous. e time we spent with an appeal process should have been the time we provide quality care to our patients. 3. Private equity investment. With the ongoing private equity investments that bought the practice le and right, I am concerned for the patients that they may not get the quality care they deserve. e physicians lost their autonomy and ultimately some of their decision making. e first goal of the investors is to make money. Quality is not equal to the cheapest product, procedures, etc. ink about it in our daily life. Excellent-quality products are not cheap unless you lower your expectations or you use the similar, aka low-quality product. n The future of ASCs is specialized, CEO says By Riz Hatton M ichael Boblitz, CEO of Tallahassee (Fla.) Orthopedic Clinic, connected with Becker's on July 28 to discuss the benefits of specializing care. Editor's note: Responses were edited lightly for clarity and brevity. Question: What trend should ASCs jump on next to be successful? Michael Boblitz: Quality, outcomes and financial performance are critical success factors for ambulatory surgery centers. The concept of the clinically focused factory is well-documented and demonstrates specialization leads to more efficient care with reduced variation and better outcomes. A historical challenge with surgical care whether that be in the hospital or an ASC is the multispecialty model makes it extremely difficult to compete. Spine and joint replacement services have historically been performed predominantly in the hospital setting mingled with the wide range of surgical specialties that span well beyond orthopedics. At Tallahassee Orthopedic Clinic these services now reflect 75 percent [of cases] plus outpatient case mix. A key trend for the ASC model is to replicate the environment for spine and joint replacement surgery to realize the benefits of specialization: superior efficiency, less variation, less length of stay and better outcomes. This involves designing a spine and joint replacement surgical center that affords the ability to care for complex patients that require a 23-hour stay, along with the comprehensive range of robotic solutions that span the O Arm Spine Imaging System, Mako and Rosa, which orthopedic surgeons require for best practice. The broader benefits reflect the patient being back in the comfort of their home in a matter of hours, along with a 30 to 40 percent lower cost for the payer and employer. At the same time this solution provides a needed relief valve for the hospitals that must prioritize the higher cost complex and emergent patient population. I see orthopedics evolving into two ASC models in the future which operate in parallel to one another. This design yields the benefits on specialization of staff, resources and destination level facilities: 1. Spine and joint surgery centers 2. Outpatient orthopedic surgery center to service the other orthopedic divisions With recent reports now indicating orthopedics ranks second in total cost of care in the commercial payer environment (behind cancer and now ahead of cardiovascular), the time has come for a better model to bend the curve and improve value. n

• Cover