Becker's ASC Review

10 ASC MANAGEMENT The rise of orthopedics in ASCs By Riz Hatton O rthopedics is the most common specialty for ASCs in 2022, according to March data from the ASC Association. Here are insights from two CEOs and an orthopedic surgeon on what orthopedics has to offer ASCs and why the specialty has been so successful in the surgery center industry. Editor's note: Responses were edited lightly for clarity and brevity. Michael Boblitz. CEO of Tallahassee (Fla.) Orthopedic Clinic: 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. 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. Alexander Sah, MD. Orthopedic surgeon in Fremont, Calif.: So the nice thing about when orthopedic surgeons work closely with ASCs to provide this specialty care is that you can provide much better and efficient orthopedic care, because you're not distracted by the other challenges of the main hospital. So in the main hospital, you're going to have other surgeries, you're going to have emergencies, you're going to have shortages of staff, people are going to get pulled in different directions. But the movement of orthopedics to ASCs is almost creating a specialty-like hospital so that you could really fine-tune the care to that specific procedure so that you can do more cases more efficiently, more safely for the patients and have better overall outcomes. So that's where that partnership between surgeons and ASCs have an opportunity to continue to grow. n Why cardiology is ASCs' next big thing By Patsy Newitt A SCs have seen a massive opportunity for growth in cardiology in the last few years, as payers and CMS see financial gain in performing these procedures in the ASC setting. Cardiology procedures received the highest estimated Medicare payment increases in 2021, making it the fastest growing ASC specialty, according to Avanza's "2022 Key ASC Benchmarks and Industry Figures" report. Additionally, a 2020 Bain & Co. report projected that by the mid-2020s, 33 percent of cardiology procedures will be performed in ASCs, a 23 percent increase from 2018. ASC leaders are seeing this play out on the policy side, with CMS adding cardiac procedures to the ASC-covered list. "In the near future we will see more orthopedic, spine and cardiac procedures in the ASC setting," Cherise Brown, administrator of Andover (Kan.) Surgery Center, told Becker's. "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." ASC chains are also seeing this opportunity. This year, Brentwood, Tenn.-based Surgery Partners inked a deal with ValueHealth to expand access to high-value surgical care. Alongside a value-based focus, the partnership will also try to capitalize on cardiology's migration to the outpatient setting. In June, Atlas Healthcare Partners, a company that manages and develops ASCs, partnered with MedAxiom to create a joint venture specializing in improving cardiovascular care in surgery centers. The company will collaborate with health systems and physicians to improve patient outcomes, patient experience and access to cardiovascular care. Single-specialty cardiology ASCs, like the new Cardiovascular Experts of Central Pennsylvania ASC in Camp Hill and the Pacific Cardiovascular Surgical Center in Salem, Ore., are increasing in popularity. Existing ASCs are adding stationary catheterization labs to their centers or higher-acuity procedures such as cardiac rhythm management to their portfolios. Payers are also taking note. In July, Aetna dropped its policy to not cover cardiac PET/CT scans following a joint letter from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine and Molecular Imaging. "I do see cardiology as a trend there as well," Randy Reynolds, senior vice president of field operations for HealthCrest Surgical Partners in Edmond, Okla., told Becker's last year. "Cardiology is probably the biggest thing coming forth, especially with all the codes that CMS has added to the list." n

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