Becker's ASC Review

14 THOUGHT LEADERSHIP What does it take for ASCs to be successful in value-based care? By Riz Hatton H ealthcare has begun its migration to value-based care, and ASCs seem primed for success in the new model. Michael Boblitz, CEO of Tallahassee (Fla.) Orthopedic Clinic, recently connected with Becker's to discuss value-based care in the ASC industry. Editor's note: is response was edited lightly for clarity and brevity. Question: How do you see the movement toward value-based care changing the landscape for orthopedic ASCs? Michael Boblitz: If you ask 10 administrators how they define [value-based care], you're probably going to get 10 different answers. Value-based care at a high level just means, "How do you improve quality and reduce costs?" By taking a patient who historically has joint placements at a hospital and moving them into our surgery center, we're reducing cost of care by 30 to 40 percent. Creating kind of narrow networks are things we're talking about with the insurance companies. We've started to engage in direct- to-employer contracting. ere's these new companies that are out there and I don't want to speak about one versus the other, they all have pros and cons. We're starting to get more into direct-to-employer contracting all around narrow networks where you're seeing these narrow networks now that if they don't participate, they're driving patients hours and hours away to a facility that does and their aim isn't surgery centers. It's kind of a combination of how to have better quality and lower cost. I think for quality, the key is having very good physicians with an outpatient mix of 75 percent in joint replacement and spine surgery as examples. at's kind of toward the top of the range for the industry average. en that robotic platform allows for minimally invasive techniques that other practices can't offer. e thing about quality is you got the experience, the procedure itself. But what about what I call longitudinal quality? Yeah, we might get that patient in a couple of hours, but how do we know they're really better three months from now, six months from now or nine months from now? We have what we call patient-reported outcomes, and we're not the only ones to do that. If you choose to get vaccinated, then you get this little text every so oen aer so many months checking in to see how you feel. It's a very similar technology to patient reported outcomes. So our patient that gets a joint replacement, receives constant communications electronically, and the series of questions allows us to know if their range of motion really is better or if their pain level is really less. We're able to share that with the insurance companies to say, "Hey, not only is the patient getting good care at that one time of the surgery, but our data is showing that we're really improving the quality of life for that patient for the foreseeable future aer that procedure." We track the patient for upwards to a year aer and the insurance companies are really interested to see that because obviously they don't want to pay for a surgery and then find that patient's surgery is not successful and is back in surgery or back in other healthcare environments six or nine months down the road. So that's why we're really doubling down on patient-reported outcomes to track that really closely and make sure that long term, patients really are better and in our case, that's what we're seeing and the payers really like what the data says. n Anesthesiology's biggest controversies By Patsy Newitt Four anesthesia leaders joined Becker's to discuss the biggest controversies in the industry today. Editor's note: This response was edited lightly for brevity and clarity. Adam Spiegel. CEO of NorthStar Anesthesia (Irving, Texas). One of the more challenging trends we've seen in many markets is that hospitals are increasingly trying to win back volume lost to ASCs during COVID-19 by increasing their surgical capacity. They have done this at the expense of running efficiently. We've seen our hospital partners increase surgical capacity (number of rooms they are staffing with anesthesia care) by 15 percent nationally since 2019, yet volumes at those centers have decreased by more than 2 percent. This trend creates an unnecessary demand for anesthesia providers, making an already challenging workforce issue much worse. Javier Marull, MD. Anesthesiologist at UT Southwestern Medical Center (Dallas). The most controversial trends in anesthesiology are the buyouts of physician practices by management companies. These companies have turned anesthesia practices into businesses. Anthony Lawson, MD. CMO of Quantum Anesthesia Services (Chicago). Medicare says ultrasound guided regional anesthesia is now the standard of care, yet CMS, as of January 2023, will not reimburse for the ultrasound guidance in regional anesthesia. The average U.S. machine costs $25,000 without the bells and whistles. No longer is it safe to do the blocks without U.S. guidance. This is a cost incurred by the anesthesiologists for which CMS refuses to remunerate. David Beardsley, MD. Anesthesiologist at Maria Parham Medical Center (Henderson, N.C.). Labor shortages, increasing complexity of aging population, new technologies/medications, COVID-19, illegal drug epidemic and unrealistic expectations for end-of-life care. n

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