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38 HEALTHCARE REFORM T he best specialties and proce- dures for ambulatory surgery centers in the future will be the traditionally inpatient cases leaving the hospital for an outpa- tient setting. Orthopedic total joint replacements, spinal surgeries and bariatric surgery are a few examples. Minimally invasive procedures and advances in anesthesia and pain management allow physicians across the country to perform these cases in an ASC, and ASCs are waiting with open arms. And some hospitals are happy for the extra operating room space as well. "If you can unburden the hospital from something that's costly and bring it to an environment where it costs less, it's beneficial," says Fred Davis, MD, president and co-founder of ProCare Systems. "e diseases of the aging population will have a huge impact over the next several years; orthopedic and neuromuscular conditions are number one with heart disease and cancer care right behind." e more progressive hospitals are joint venturing with physicians on ASCs and aligning with the outpatient provid- ers in their communities to build larger perioperative surgical homes and campuses that could transform the healthcare expe- rience. ASCs traditionally focused on just the surgical episode — physicians' offices coordinated pre- and postoperative care, and sent patients to separate providers for rehabilitation. But this is no longer acceptable in the age of integrated medicine. "e bigger picture is how ASCs are going to fit into the transformation of the perioperative surgical home and systems of care covering the episode of care," says Dr. Davis. "How can ASCs best prepare themselves to integrate with the episodic and chronic care patients require?" Partnerships are one solution. ASCs are working with other independent providers in their area, including physical therapy, rehabilitation, home health services and surgical nursing facilities to create medical campuses or virtual complexes addressing the continuum of care. e medical home can help with pre-procedure counsel- ing, weight loss and smoking cessation. ey're also including non-traditional health services, such as nutritionists, psycho- logical and behavioral care and fitness experts. "is embeds the ASC in the healthcare system and makes them more indispensable," says Dr. Davis. "You need a strategic vision for how the system will work and the leadership to bring all the parties to the table. You have to have enough clout with- in all the organizations involved. You need a champion, but also the decision-maker must be high enough in the organiza- tion to make the collaborations happen." e key elements for building a perioperative medical home include: 1. A strong leader with the right clinical skills and respect from their peers to take the helm. When physicians don't have the time or expertise to lead, they'll work with management com- panies to organize all parties involved. "Now you are getting a whole class of physicians who are understanding the business world and bridging the gap between clinical and administrative functions," says Dr. Davis. 2. Becoming part of a larger organization, whether it's the perioperative medical home or part of a hospital system, gives the organization negotiating power and leverage. "ese or- ganizations will be viable if they can deliver an excellent work experience where they can work at the top of their license and others can handle the management side of the practice," says Dr. Davis. 3. e larger organizations allow physicians control over their clinical and professional life. "ere will always be physicians who want to work where they are appreciated, contributing and adequately reimbursed where they are respected and have some control," says Dr. Davis. is is where ASCs and large independent physician organizations will thrive. 4. Health information technology is the foundation of the larger organizations. e information technology helps people collaborate and provides data portability to multiple locations. "You can't do this without health IT, leadership and management," says Dr. Davis. "ere are more freedoms with more data collection and transparency. You can become more independent because information technology disrupted the entire field." 5. e aging population will drive healthcare trends going forward, including the desire for integrated care in the periop- erative medical home. e aging population will drive volume including orthopedic surgery, cataract surgery and colonosco- pies. "We have a lot more information available about who our patients will be and we can tailor our operations toward them," says Dr. Davis. n Healthcare is Barreling Toward Integration — 5 Key Thoughts By Laura Dyrda Dr. Fred Davis