At the 21st Annual Becker's ASC Conference in Chicago on Oct. 23, Charles Dailey, vice president of business development of ASD Management, described the increasing value of integrating spine and joint arthroplasty into the ASC setting, as well as key considerations for achieving successful integration.
As the aging population requires more spine and total joint care, the shift to outpatient care is evolving for pain management and minimally invasive procedures, while also managing cost constraints, according to Mr. Dailey. Spine and joint care ASCs have the potential to offer comparable or even better care than hospitals, reduced costs and high reimbursement and improved patient satisfaction.
However, Mr. Dailey stressed certain factors can make or break the success of a spine and joint ASC.
1. Is the community ready? Understanding the expectations of the community surrounding the ASC should be a priority, Mr. Dailey explained. It is essential for ASC developers to have insight into the community standard and know what the community is used to in local areas. Will the community be open to outpatient spine and joint procedures?
2. Integration coordination can significantly influence outcomes. Pre-operational planning as well as post-operation programs should be incorporated into the ASC's plan. "All members of the team should be on the same page. The whole team — those involved other than surgeons — will impact the success or failure of these programs," Mr. Dailey said.
3. Evaluate costs and reimbursement. A spine and joint ASC will have direct costs, such as implants, and indirect costs, including facility, staff, support equipment and operation room use, Mr. Dailey explained. "Instead of just being on the defensive looking at how much costs are, also be on the offensive and assess reimbursements," he said. "As a facility, you need to prove to the primary payers that this will not cost more than it makes."
4. Ensure the facility is up to par. Mr. Dailey outlined a series of questions to help evaluate the facility itself: Is it the best use of the ORs? Will you be displacing other cases or providers? Does the scheduling fit the facility's "best use of ORs?"
5. Can the facility accommodate the necessary equipment? Spine and Joint ASCs will require a specialized OR table and attachment, positioning equipment, computer systems and spine-specific equipment. Additionally, staff must be trained and comfortable with the equipment, Mr. Dailey said.
6. Choose experienced surgeons. "Credentialed isn't the same as 'best fit.' An ASC is not a place to learn," Mr. Dailey said. Additionally, surgeons should have an established 'profile' that includes the rates of complications and readmissions, knowledge of equipment needs and accurate estimations of procedure times.
7. Accurately set patient expectations. "Nothing is painless," Mr. Dailey said. "It's important for patients to have personal support systems in place already for post-operational monitoring." Providers must also communicate the perioperative risks to the patient.