12 Things to Know About Spine & Higher Acuity Cases in ASCs

At the 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine in Chicago on June 12, Jeff Leland, CEO of Blue Chip Surgical Center Partners, discussed the forces driving the shift of higher acuity cases to ambulatory surgery centers and how ASCs can add specialties such as spine and total joints.

Driving forces
There are three major disruptive phenomena behind the shift of higher acuity cases from the hospital to ASCs.

  • Technology. From the rapid advancement of minimally invasive techniques to new instrumentation and implants, technology is allowing surgeons to limit blood loss and decrease recovery times for cases that have historically been solely performed in hospitals. Advances in anesthesia have dramatically changed pain management, allowing significantly more to be done in the outpatient setting.  
  • Surgical migration. As patients take more control of healthcare decision-making and healthcare stakeholders continue to look for ways to hone in on quality care at a lower cost, appropriate cases are migrating away from the inpatient environment to the outpatient. "Moving to the ASC is really the biggest opportunity to lower cost, especially with higher acuity cases," said Mr. Leland.
  • Payment uncertainty and the shift to value-based compensation. "Fee-for-service compensation is dead," said Mr. Leland. The move away from FFS has created a great deal of uncertainty across the full spectrum of healthcare. ASCs, if positioned correctly in the market, stand as beacons for the goals of value-based care: high quality service, excellent outcomes and low cost.


There are a number of specialties that offer ASCs opportunities to add higher acuity cases.
  • Orthopedics. Total joints are a frequently talked about addition in the ASC industry.
  • Spine. Spine procedures such as laminectomy, cervical fusion, disc replacement and more have been safely and successfully performed in the ASC environment for years, and the opportunity for more continues to grow.
  • Bariatrics. "Bariatrics is a tough market," said Mr. Leland. "But, there is a lot of opportunity [for ASCs]."
  • Neurosurgery. "In the last six months, I have had inquiries from multiple neurosurgeons about angiograms," he said. There is the potential to create an ASC model for angiograms, relatively simple tests.
  • Gynecology. Hysterectomies have traditionally required hospital stays and extended recovery periods, but surgeons have begun performing minimally invasive laparoscopic hysterectomies. Patients can go home hours afterwards and return to work in less than a week: a perfect match for the ASC setting.
  • Plastics. Though a niche market, Mr. Leland has observed a Blue Chip center that has had a plastic surgeon successfully, and profitability, introduce transgender surgery.

Higher acuity cases in practice

High acuity cases can be a profitable option for ASCs. A spine-driven ASC that performs 350 to 500 spine cases and 1,000 pain management cases per year can create a 100 to 150 percent return on investment, said Mr. Leland. But, before realizing high acuity success ASC leaders must determine how to transition those cases into practice.

  • Patient selection. Physicians, supported by the ASC team, must have an organized and thorough process of patient selection. Only appropriate candidates can be safely brought to ASCs for high acuity procedures.
  • Protocols. Before even performing a case, an ASC must have structured protocols for any possible issue associated with the higher acuity cases. Each physician and ASC team member should be well-versed in all protocols.
  • Additional services. Depending on state regulations, ASCs can add 23-hour stay capabilities. Will the higher acuity procedures require stays of that length? If not, will patients need home health services prepared to meet them at their home? Any needed additional services will be structured and in place well before the first case.
More Articles on ASC Issues:
Surgical Center of Connecticut Relocates to Bridgeport
Sheridan Deal, Development Activity, Q1 Financial Reports & More: 9 Recent Key Notes on AmSurg
7 Things for ASC Leaders to Know for Thursday

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