Becker's ASC Review

17 JOINT VENTURES Syracuse Orthopedic Specialists to Build New $13.5M ASC for Expanded Volume, Complex Procedures: 7 Key Notes By Laura Dyrda A Syracuse, N.Y.-based orthopedic group planning to expand its exist- ing surgery center to Cicero, N.Y., according to a Syracuse.com report. Here are seven things to know: 1. Syracuse Orthopedic Specialists wants to expand its outpatient surgery center, Special- ists' One Day Surgery, by moving to a new building in Cicero that was previously used as the headquarters for Wynit Distribution. 2. e practice plans to convert its current surgery center into a pain management facil- ity. e 16,642-square-foot center includes six operating rooms and two procedure rooms. 3. e existing center isn't configured for more complex procedures, including spine and joint replacement surgeries, and the new facility would allow surgeons to perform the larger procedures outpatient. Syra- cuse Orthopedic Specialists CEO Michael Humphrey estimates the center will attract 10 percent more patients than the current center, increasing case volume to between 8,000 and 9,000 patients per year. 4. e new 47,713-square-foot facility will include eight operating rooms in addition to an extended recovery area. e center expects to discharge most patients the day of surgery, but the facility will have 12 beds for overnight stays. 5. e new center is expected to cost $13.5 million, and owners applied for $2.3 million in tax exemptions over 10 years for the new facility, including $1.7 million in property tax discounts. However, the center's owners withdrew the request aer opposition from the community. 6. When completed, the center expects to attract 40 percent of its patients from outside of Onondaga County and predicts annual rev- enues from those patients would hit around $14 million. e new facility would also create 40 new jobs and retain the 57 positions cur- rently employed at the existing surgery center. 7. e new ASC has state approval and the physicians expect to open the facility in early 2019. n Outlook for Total Joint Replacements in the ASC: Key Concepts From Dr. Thomas K. Miller By Laura Dyrda T homas K. Miller, MD, is the section chief of sports medicine at Carilion Clinic in Roanoke, Va. He has long championed orthopedic procedures in the ASC and has a deep understanding of the roadblocks to, as well as opportunities for, outpatient total joint replace- ment. Question: What is the biggest roadblock you see to a nationwide trend of total joints being performed in the ASC? How can the industry jump-start more total joint centers? Dr. T.K. Miller: From a fiscal perspective, centers are still limited by CMS constraints, although that seems to be changing with the expected permission to perform total knees in ASCs. With the realization that for select patients, nonhospital-based care represents fiscal responsibility and optimized use of resources, it is reasonable to expect other arthroplasty procedures will receive CMS approval to be performed in the ASC environment. Until that time, successful centers will need to continue to validate the net value (not just upfront cost, but also quality meeting or exceeding hospital-based services) as they develop viable contractual relationships with commercial carriers and large self-insured entities. With strict perioperative protocols and realistic patient selection, from a global cost perspective, freestanding ASCs can be expected to be seen as the more fiscally appropriate sites of care, rather than hospital-associ- ated ambulatory sites for a large number of patients. Industry support in the form of cost-competitive implants, DME supplies and other procedure and perioperative-based expenses (perhaps as a total joint "package") will allow centers "on the fence" to per- form fiscal reviews and may engage sites not currently willing to assume the financial risk of developing and advancing a program. Q: Where do you see the biggest opportunity for growth among total joint programs at ASCs? Where can orthopedic ASCs grow the most over the next 5 years? TM: Expansion of operative services to include anterior-approach total hips seems to be the procedure that best fits patient profiles, pain management requirements, immediate perioperative needs and ambulatory ability post-procedure, and should be a prime opportunity for growth. Shoulder arthroplasty is also an underconsidered proce- dure at this time. The other site of growth continues with spine. Not just limited exposure and single-level interven- tion, but extended level fusion, especially if extended stay or 23-hour capability is included. n

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