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42 ASCs Save $2.3M for Knee, Shoulder Surgery in California in 2 Years: 5 Key Notes By Laura Dyrda Key Specialties A new study published in the Journal of Bone and Joint Surgery shows patients prefer outpatient ambulatory surgery centers to hospital outpatient facilities, par- tially due to lower costs associated with ASC procedures. Researchers gathered data from 3,962 patients in the California Public Employees' Retire- ment System who underwent knee arthros- copy or shoulder surgery in the three years before implementing reference-based benefits and compared them to 2,505 CalPERS patients who had surgery in the two years aer imple- mentation. ere was also a control group of 57,791 patients who did not have reference- based benefits. e researchers found: 1. In the second year of the program, there was a shi towards freestanding ASC use. ASC uti- lization increased 14.3 percentage points for knee arthroscopy and 9.9 percentage points for shoulder arthroscopy. 2. When the ASCs experienced an increased utilization, hospital-based outpatient facilities showed a decrease in utilization. 3. e average price for a CalPERS beneficiary fell 17.6 percent for knee procedures and 17 percent for shoulder procedures. 4. e reference-based benefits shi wasn't asso- ciated with a surgical complication rate change. 5. In the two years aer reference-based ben- efits, CalPERS saved $2.3 million — or 13 per- cent — on knee and shoulder arthroscopies. n The Fate of the Small GI Practice: Independence or Strength in Numbers? By Maxwell Chait, MD, ColumbiaDoctors Medical Group in Hartsdale, N.Y. A lthough many independent practices are opting to become part of a hospital system or a larger prac- tice to stay in business, smaller gastroenterology practices may be able to survive. For a smaller GI practice to survive, practice leaders need to evaluate the market and competitors and assess the practice's financial situa- tion to become more competitive compared to practices of similar or larger size in its local market. When deciding whether to remain independent or participate in these arrangements, GI practices need to analyze the risks and benefits of the joining other practice arrangements or remaining as an independent GI practice. Some of the more critical criteria regarding the decision of the GI practice to become part of a hospital system or larger practice include the loss of control over the direction and operation of the practice, the implica- tions of being an employee rather than a business owner and the ability of gastroenterologists and employees to function effectively and thrive profes- sionally in the different larger culture. To remain in business, practice leaders need to assess their EMR and oth- er technology solutions that will either contribute or diminish produc- tivity and efficiency, evaluate insurer contracts and delivery systems to assure the financial integrity of the group, know which providers give the highest value of quality, access and cost for the GI practice and its patients and assess staffing of clinical and non-clinical employees for the volume and acuity of patients to move into this new healthcare world. Essentially, GI practice leaders must have the necessary skills for data analysis and strategy and understand the financial situations they will face as the new healthcare system evolves. n BECKER'S SPINE REVIEW E-WEEKLY subscribe today free • educational • up-to-date Visit beckersorthopedicandspine.com or call (800) 417-2035