Issue link: https://beckershealthcare.uberflip.com/i/1499344
Orthopedic Procedures: A Strategic Move for ASCs By Scott Allen, Senior Vice President of Managed Care Contracting at nimble solutions A n aging population is one of the primary drivers of the increased demand for orthopedic procedures. As people live longer, they are more likely to develop conditions such as osteoarthritis and other degenerative joint diseases that require surgical intervention. is has led to an increase in the number of orthopedic surgeries including total hip and knee joint replacements, Anterior Cruciate Ligament (ACL) reconstruction and shoulder arthroscopy. According to the Ambulatory Surgery Center Association (ASCA), ambulatory surgery centers (ASCs) oen have several areas of specialties, with orthopedics being one of the most common in 2022 among Medicare-certified ASCs. With more orthopedic procedures being performed on an outpatient basis, there is an increasing need for ASCs. ese centers offer a cost-effective and convenient alternative to hospital-based surgeries, making them an attractive option for patients and healthcare providers. ASCs can position themselves for success and capitalize on the financial gains and growth potential of orthopedic procedures. However, it is important to note that success in this area requires ongoing commitment, investment, and a focus on continuous improvement. Review payer contracts to ensure fair reimbursement rates. When reviewing contracts, providers should compare reimbursement rates, look for hidden fees, understand the payment schedule, consider the impact of bundled payments, and monitor changes in reimbursement rates over time. Benchmarking nimble data shows that complex orthopedic procedures such as total knee arthroplasty can bring in an average reimbursement of $11,000 - $13,000 per case and can produce 50% margins in ASCs. Nimble has seen that multi-specialty ASCs can increase their monthly revenue by upwards of $300,000 by adding an incremental 30 total knee cases per month, which could translate to $150,000+ of incremental monthly profits. Before adding orthopedic procedures to your service line, compare your reimbursement rates by payer to the cost per case. If your costs are higher than your reimbursement, you can work with payers to renegotiate contract terms to benchmark rates. Invest in orthopedic technology, build relationships with referring physicians. Investing in orthopedic technology and building relationships with referring physicians can help healthcare providers stay competitive in the orthopedic market. Advances in orthopedic technology are helping to improve patient outcomes and reduce costs. Healthcare providers who invest in these technologies, such as robotic-assisted surgery or 3D printing, can offer patients more advanced treatment options. is can help to attract more patients and differentiate the provider from competitors. Referring physicians play a critical role in driving patient volume to ASCs. e best way to build relationships is to ensure local physicians are aware of your capabilities and services, including advancements in surgical techniques and technology. Advanced imaging and robotic-assisted surgical systems can improve patient outcomes, but they can also attract new patients to your ASC. As patients are becoming more informed and tech- savvy, they may ask their doctor to refer facilities with the most advanced orthopedic care. Focus on patient outcomes and value-based care. Patients are increasingly empowered to make choices about their healthcare providers. Recent consumer surveys have shown 78% of orthopedic patients prefer ASCs over hospital or hospital outpatient (HOPD) settings due to lower costs and higher quality of care ¹. Value-based care oen involves a shi from fee- for-service reimbursement models to alternative payment models, such as capitation or bundled payments, that reward providers for delivering high-quality care that meets specific performance metrics. is approach aims to align incentives across the healthcare system, improve patient outcomes and reduce costs. Your ASC can focus on delivering the best possible outcomes for your patients by hiring skilled and experienced surgeons, providing comprehensive pre-operative and post-operative care, and using evidence-based practices to ensure that patients are receiving the most effective treatments. Hiring a comprehensive care team can be highly effective in helping your facility build a reputation for excellence, which can attract new patients and help you stand out in a competitive market. Monitor and improve revenue cycle performance. Revenue cycle management is a critical function in healthcare organizations that focuses on the financial processes associated with patient care, including billing, payment, and reimbursement. ASCs should continuously monitor and improve performance to deliver high-quality, cost- effective care, including identifying opportunities to improve revenue cycle efficiency. For example, if you've noticed a pattern of inaccuracies in patient demographics or prior authorizations due to manual data entry, automation within your front-end process can help catch errors before claims are submitted. Integrating dictation and transcription into your RCM workflow can also improve the turnaround time between transcription and coding and decrease coding errors. Analyzing your claims history will also help you determine how oen you perform procedures and which cases currently bring in the most revenue. is data can also help you secure competitive rates with payers on the most frequently performed procedures or the procedures with the greatest expenses, such as implants. ASCs can use the data for improvement and develop strategies to optimize revenue cycle performance. is may involve streamlining billing and payment processes, improving coding accuracy and documentation, and implementing technology solutions to automate manual processes and improve efficiency. Orthopedics can position your ASC for long- term success. Overall, the shi towards outpatient orthopedic procedures presents several opportunities in the healthcare industry, including increased demand for ASCs, growth of the orthopedic device market, expansion of specialized services, and increased focus on patient satisfaction. As the demand for orthopedic surgeries continues to grow, so does the number of multi-specialty ASCs that offer these procedures. Orthopedic surgeries represented 37% of the total volume of ASC procedures in 2022, and that number is expected to rise significantly in the coming years ². Reviewing managed care contracts, investing in the latest technology, focusing on patient outcomes, building relationships with referring physicians, and monitoring and improving performance will help differentiate your facility from local competitors. Visit nimblercm.com to maximize revenue, gain insightful analytics, and achieve powerful financial results. Resources: 1. Why Improving the Patient Experience Is Vital for the Health Care Industry and How To Do It - SPONSOR CONTENT FROM SIEMENS HEALTHINEERS (hbr.org) 2. https://vmghealth.com/thought-leadership/ blog/ascs-in-2022-a-year-in-review n