Becker's ASC Review

10 THOUGHT LEADERSHIP it comes to cases that can be seen with use of telehealth visits. e second part of my answer related to staffing will be to look at providing flexible staffing hours and crossing training the same staff to step into multiple roles if they have practices that house more than one specialty. Les Jebson. Regional Administrator at Prisma Health (Greenville, S.C.): An aging population converging with insurer pressures will continue to propel ASC growth. From 1996-2006 outpatient surgical cases tripled, whilst hospital-based surgical procedures generally remained flat. Aligned reimbursement programs through case rates for select procedures in orthopedics and vascular care will continue to push the migration to the outpatient arena. Cost shiing to the ASC arena by insurers will further reduce costs. e beneficiaries of these savings will be mixed. How much will this growth be in the next five years? e ASC market is projected to grow to $59 billion by 2028. A growth rate of about 30% vs. 18% for hospital outpatient departments and ASCs. Neal Kaushal. Gastroenterologist in Sonora, Calif.: I see colon cancer screening programs as the biggest opportunity for growth in the ASC industry over the next five years. With the recent revision of screening guidelines to start screening at age 45, as well as many institutions still navigating elective endoscopy case backlogs from the COVID-19 era, the demand for endoscopic services nationwide has reached an all time high. Furthermore, cost pressures are increasingly – and almost exclusively – pushing elective screening procedures to the outpatient ASC setting. is represents a significant opportunity – both clinical and commercial – for GI groups and institutions to capitalize on providing quality patient care in a manner that is both cost efficient and profitable. is is also one of the main drivers of private equity firms into this space, as health system consolidation efforts continue. Earl Kilbride, MD. Orthopedic Surgeon at Austin (Texas) Orthopedic Institute: Orthopedics traditionally has been an inpatient or at least an "overnight stay" specialty. As techniques of the procedures and efficiencies of the ASC world improve, many, if not most, of the elective and urgent orthopedic surgical procedures can move to the outpatient setting. Procedures such as total joints, spine fusions and complex fractures can all be safely done. Additionally, newer procedures being adopted by orthopedic surgeons such as neuromodulation can enhance the ASC growth. Benjamin Levy III, MD. Gastroenterologist at University of Chicago Medicine: e U.S. Preventive Services Task Force and the major Gastroenterology societies recently changed their guidelines to begin screening colonoscopies at age 45 due to an uptick of colorectal cancer diagnoses at age 49. Approximately 19 million Americans between the ages of 45-49 now need screening colonoscopies so there is a huge, new demand for Gastroenterologists and ASCs to increase the number of procedures performed daily. Unfortunately, we are continuing to see an increase in early onset colorectal cancer cases. Over the next 5 years, ASCs will have the opportunity to ramp up throughput goals and to increase productivity. Many ASCs are positioning themselves to insurance companies as a cost-effective alternative to hospital-based colonoscopies. ASC colonoscopy volumes will likely continue to rise to accommodate the growing patient volume. e increased use of alternative screening modalities such as Cologuard, FIT, and Shield (the first FDA approved blood test for colon cancer screening) will expand procedural demand at ASCs who can quickly schedule these follow-up colonoscopy procedures. To increase growth, ASCs should streamline scheduling for primary care physicians to facilitate short wait times. Justin Marburger. Director of Surgical Services of Plastic and Cosmetic Surgery Center of South Texas: I believe the biggest opportunity for growth for ASCs in the next five years is to implement a multimodal ERAS (early recovery aer surgery) program aiming at patient education, optimized nutrition, regional anesthesia, multiple pain management avenues and careful fluid management. e goal is to minimize complications, reduce overnight stays and enable patients to return to normal activities sooner thus allowing more surgeries into ASCs and out of the hospitals. Patients prefer having procedures done at ASCs rather than in hospital and continued improvements in postoperative recovery will allow more invasive procedures to be done at ASCs. Brett Maxfield. Director of Anesthesia and Surgical Services at Teton Valley Health Care (Driggs, Idaho): In my work around the US and around the world, I am seeing increasing physician dissatisfaction with their surgery situations in the hospital, and an increased desire for more autonomy. I see the opportunity for growth continuing with these individuals who would like to be able to have control over their own surgery schedules, staffing, etc. On the flipside, I have also been approached by multiple large hospital systems who are interested in increasing their ASC footprint. With both of these factors working in our favor, I see ASC growth continuing to go strong over the next five years Sumana Moole, MD. Gastroenterologist at Merus Gastroenterology & Gut Health (Suwanee, Ga.): I believe that a significant growth opportunity for ASCs in the next five years lies in expanding the range of services they offer and adopting advanced techniques traditionally reserved for hospital settings. For instance, offering procedures like endoscopic ultrasound, endoscopic submucosal dissection for gastrointestinal neoplasms in an ASC setting could be transformative. ere are a range of other services that can be offered in ambulatory units such as capsule endoscopy, manometry, Barret''s ablation etc. ASCs typically demonstrate better outcomes, shorter stays, and reduced costs. Integrating new technologies and AI would allow ASCs to broaden their service offerings considerably. Furthermore, the increased use of screening tools like Shield and Cologuard, especially in underserved areas, will likely lead to a greater demand for colonoscopies. is demand is further fueled by the rising incidence of chronic diseases and colorectal cancer diagnoses in younger populations. ASCs can provide a more cost-effective option for colonoscopies, benefiting patients and the healthcare system. Expanding ASCs in underserved areas with limited hospital access represents another major growth opportunity. Daniel Mulconrey, MD. Orthopaedic Spine Surgeon at Midwest Orthopaedic Center (Peoria, Ill.): It is difficult to speculate with spinal surgery. Spinal surgery has and continues to expand its position in the outpatient surgery market. Advancements in robotics, navigation and minimally invasive techniques continue to be at the forefront. However, navigation in the outpatient setting will improve the accuracy and safety of these minimally invasive procedures. is benefit should inevitably increase the volume of procedures being performed in the ASC. e challenge will be minimizing expenses for navigation. Advanced imaging and navigation for the ASC would be a great opportunity for growth moving forward. Renee Oliveira. Chief Operations and Marketing Officer at Integrated Medical Care (Parasmus, N.J.): Over the next five years, the ASC industry is poised

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