Becker's ASC Review

44 ORTHOPEDIC SECTION The Future of Spine and ASCs: 5 Trends to Watch By Emily Rappleye F rom physician income to super groups, two industry leaders discussed emerging trends in spine and ASCs at the Becker's ASC 23rd Annual Meeting in Chicago. e panel included Sev Hrywnak, MD, CEO of the SEV Group, and Chris Bishop, CEO of Regent Surgical Health in Westchester, Ill., and was moderated by Barton Walker, JD, partner at McGuireWoods. Here are five trends to watch, based on the panel discussion. 1. Bundled payments. Value-based care and bundled payments are the buzzword of the moment and are the next frontier in spine surgery, according to Mr. Bishop. Empowering physicians with performance and cost data and linking it to pay aligns incentives on both cost and quality. is structure puts physicians at risk financially, positioning them to consider the payer's perspective while delivering care. "When the physician is properly incentivized you will see some changing in how we treat pa- tients," he said. 2. Hospital acquisitions. "Hospitals are going to be phased out in the next five to 10 years and will just be used for trauma and acute care," Dr. Hrywnak predicted. Smart hospi- tals are snapping up surgery centers he said, because the hospitals will not be equipped to handle the overhead for spinal procedures as deductibles continue to rise. 3. Super groups. Mr. Bishop believes the Medicare Access and CHIP Reauthorization Act, which will take effect in 2017 for pay- ments starting in 2019, will drive consolidation in the physician market because it marks the first large-scale effort to tie physician payments to quality measures. Tracking those measures requires significant overhead and business savvy, which many small-scale physicians' of- fices may not have. "If you are a two-man or -lady practice, it's difficult to have the resources to meet a lot of these regulatory standards," he said. In particular, he expects to see growth in "super groups," or extremely large groups and multistate groups, which are already forming in anesthesia and for hospitalists. 4. Physician incomes. e market will drive physician incomes down, according to Dr. Hry- wnak. He suggested a neurosurgeon who makes $750,000 annually now will be making $250,000 in 10 years because "you can't constantly keep reducing reimbursement rates, but that's what they are doing," Dr. Hrywnak said. e market drives prices, and the market is controlled by payers and CMS, he added. Paraphrasing the CEO of UnitedHealthcare, Dr. Hrywnak said the goal among payers is the following: "We only have one person we have to control to make it all work — the surgeon. … We have to change their lifestyle totally. eir lifestyle is X. We have to bring it down to Y. If we can convince them Y is good, it will work." However, Mr. Bishop disagreed that physicians will continue to see declining income on a large scale basis. He instead believes costs will be cut out in other ways, such as direct partnerships between employers and health systems, which allow health systems to treat large volumes of patients in the highest quality settings with the lowest expenses. 5. Patients have the power. "e ulti- mate payer is going to be the patient, believe it or not," said Dr. Hrywnak. He pointed to a pilot program at Danville, Pa.-based Geisinger Health System. is program queries patients through an app on their mobile devices any time they visit a Geisinger hospital or surgical group. At the end of the survey, if a patient has indicated they did not receive top-quality care it asks them if they want a refund. According to Dr. Hrywnak, this program is a look at what's to come, particularly when MACRA is in full force because some elements of the law incor- porate patient satisfaction surveys. e bottom line is "it's all about the patients," he said, and they will ultimately determine how much a physician gets paid. n Overlapping Orthopedic Surgeries: Does it Affect Quality, OR Time in ASCs? 5 Key Notes By Laura Dyrda A new study published in the Journal of Bone and Joint Surgery examined overlapping surgery in the ambulatory orthopedic setting. The study authors examined an institutional clinical database to retrospectively review cases from 2012 to 2015. The cases included sports medicine, hand and foot surgery performed in an ambulatory orthopedic surgery center. There were 3,640 cases performed with 68 percent of them overlapping procedures and 32 percent non-overlapping procedures. Here are five things to know: 1. There was no difference in procedure time or total op- erating room time; the average procedure time was 70.7 minutes for overlapping surgeries and 72.8 minutes for non- overlapping surgeries. The total operating room time was 105.4 minutes for overlapping procedures and 105.5 min- utes for non-overlapping procedures. 2. The complication rate for overlapping procedures was 1.1 percent; the complication rate for non-overlapping proce- dures was 1.3 percent. 3. The researchers reported no difference in complications when stratifying based on subspecialty surgery. 4. Half of the overlapping procedures overlapped by less than one hour of OR time; however, 7 percent overlapped by more than two hours. 5. The complication rate wasn't associated with the amount of overlap between cases. n

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