Becker's ASC Review

18 THOUGHT LEADERSHIP What procedures are migrating to ASCs? By Patsy Newitt F rom high-acuity spine to cardiac procedures, five ASC leaders joined Becker's to share what procedures they see moving to the ASC setting. Editor's note: Responses were edited lightly for clarity and brevity. Cherise Brown. Administrator of Andover (Kan.) Surgery Center: In the near future we will see more orthopedic, spine and cardiac procedures in the ASC setting. CMS recently added several cardiac procedures to the ASC covered procedure list, including diagnostic and interventional coronary procedures, peripheral vascular interventions, and placement of pacemakers and defibrillators. Quality of care, recovery time, physician autonomy and cost will continue to drive more procedures to the ASC setting. Eric Anderson, MD. Pain Management Physician in Lewisville, Texas: I think there will be an increase in the size and scope of ASC development, utilization and type of cases expanding in the pain management space; for certain cases. I think pain management implants, devices and minimally invasive treatments will continue to see preference in the ASC setting as CMS has already started preferring this route for spinal cord stimulator systems, for example. Brenda Carter. Administrator of Wilmington (N.C.) Surgcare: The future looks bright for more total joint cases in the ASC, along with spine and cardiology. The push to the ASC creates a better patient experience, reduces costs and can ease the burden on overwhelmed, understaffed hospital facilities. However, insurance carriers will need to revisit the procedures previously only allowed in the hospital setting to create an easy transition to ASCs. As the carriers have historically been slow to respond to changing trends, this may initially present some challenges. Harry Aslanian, MD. Advanced Endoscopist at Yale School of Medicine (New Haven, Conn.): There has been interest in moving endoscopic ultrasound procedures to the ASC setting. This is a feasible option should the payment structure promote a change to an ASC setting. Myrna Loida Chang, RN. Director of Surgical Services at HCA-Good Samaritan Hospital (San Jose, Calif.): I can see the following moving to ASC: total knees, one level spine surgeries, one level anterior cervical discectomy and fusions and mastectomies. n ASCs with 25%+ orthopedic case volume are best positioned to thrive, CEOs say By Alan Condon O rthopedic surgeries have increasingly shied to the ASC setting in the last 10 years as minimally invasive technology advanced. In recent years, CMS, commercial payers and patients have pushed these procedures to the ambulatory environment, where they can be done safely and at a lower cost than the inpatient setting. Here's how three orthopedic group CEOs are looking at ASC and practice growth: John Ryan. CEO of OrthoIndy (Indianapolis): Among several challenges for ASCs, I think the three most significant are procedure volume, payer contracting and case mix. Any one of these three challenges can mean the difference between an ASC that is successful and one that fails. I am no doubt biased, but orthopedics is a single solution to address all three of these challenges. Regarding procedure volume, predictive modeling in demographics points to a population boom of those seeking orthopedic care, so we know that orthopedic procedures will be a meaningful source of ASC case volume growth in the future. We also know that more and more orthopedic procedures are migrating into the outpatient setting from the inpatient setting, providing yet another source of growth in ASC procedure volume opportunity. Regarding payer contracting and case mix, a few thoughts come to mind. First, reimbursement for orthopedic cases could always be better, but as reimbursement goes, it is better than several other specialties, making it an attractive specialty to offer at an ASC. Related, I am likely stating the obvious when I say that ASCs with meaningful orthopedic volume stand a much better chance of financial viability and sustainability than those [without]. While it is absolutely possible for an ASC to be financially successful without orthopedics, those ASCs with orthopedic procedure volume at or above 25 percent have a far clearer path to navigate the other economic pressures on an ASC's financial health. Aaron Johnson. CEO of Twin City Orthopedics (Golden Valley, Minn.): Between now and 2025, we anticipate we'll need to add around 30 orthopedic surgeons. We have a dedicated individual on our Image Credit: Adobe Stock

• Cover