5 Trends Affecting Common ASC Specialties

Three ASC industry professionals — Joe Zasa, Charles Dailey and Akram Boutros, MD — share their insight on what specialties to watch for over the next year in the ambulatory surgery center industry.

Mr. Zasa is the co-founder of ASD Management, a company focusing exclusively on turnarounds, development and management consulting for surgery centers. Mr. Dailey serves as ASD Management's vice president of business development. Dr. Boutros is the founder and president of BusinessFirst Healthcare Solutions, a consulting firm.

1. Spine. Spine has long been a popular ASC specialty because of high reimbursement rates. While reimbursement rates aren't guaranteed to stay put, spinal procedures will continue to move to surgery centers as minimally invasive surgery becomes a possibility for more procedures, such as kyphoplasties, vertebroplasties and microdiscectomies.

Dr. Boutros sees spinal procedures moving to ASCs because of shorter recovery times. Any procedures for which recovery time in a hospital is less than a day to a day and a half can probably be reduced through surgical advancements, including minimally invasive procedures. Spine procedures recovery times are getting shorter and shorter, making them prime candidates for surgery center expansion.

"There is a huge population that has discogenic back problems, who don't need major surgery," Mr. Dailey says. "We see a lot of osteoporosis and obesity. Those two factors are leading to compression fractures." Moving more spine procedures to the ASC can offer a new patient population faster, more economical relief.

2. Orthopedics. Knee replacements and hip replacements will become more prevalent in ASCs, according to Mr. Zasa. He says he sees unicompartmental knee replacements performed on a regular basis and expects full knees to be done more and more in the next year. Eventually, he says, full hip replacements will be done in an outpatient setting with an extended stay option for recovery.

An option for knee replacements as the procedures transition to ASCs may be to partner with hospitals, Dr. Boutros says. "Orthopedics are beginning to see some interesting relationships between specialty ASCs and local hospitals, where surgery is performed — including knee replacements — in the ASC with 23-hour to two-day recovery stays at a nearby hospital," he says.

This partnership option allows patients to receive additional recovery time with all the benefits of a specialized ASC.

"The cost is significantly lower in an ASC and you have the significant specialization so the outcomes get to be better," he says. "The hospital operating room does everything. It's hard to have a dedicated team to specialize."

3. Gastrointestinal. GI procedures have seen reduced popularity as reimbursement rates drop, but Mr. Dailey says not to give up on the specialty all together.

"We are trying to develop programs for GI and focusing on colon cancer screening," he says.

As a marketing initiative for ASD Management, Mr. Dailey works to get surgeons interested and trained in a greater variety of specialties to bring more diversity and larger case volume to their ASCs.

4. Technological advancements. Several procedures will gain surgery center traction through the emergence of new technology. Robotics-assisted procedures will also become more prominent in ASCs, Dr. Boutros says. Due to the high cost of purchasing robots, most surgery centers have shied away from the investment. However, as the technology evolves in the next year, robots will be introduced to more surgery centers.

Dr. Boutros expects gynecological and urological procedures will begin to take advantage of robotic techniques. "These two areas are ripe for robotics," he says.

Mr. Zasa expects to see ASCs implement spinal cord stimulator implants and neuro stimulators for back pain as well. Mr. Zasa and Mr. Dailey believe the more procedures that can be done in ASCs, the better for everyone involved.

"There is so much pain out there that needs to be addressed," Mr. Dailey says. "Within all these disciplines, there are prime examples of procedures that can be done at ASCs. This means a growing market for physicians, and ultimately the patients are going to be the winners."

5. Cosmetics and gynecology. While many specialty procedures are moving to surgery centers in increasing numbers, cosmetic and gynecological procedures may be less frequently performed in ASCs.

"With gynecology, they can do procedures with minimal sedation, and with minimal sedation they can be in an office and make more money," Mr. Dailey says.

Dr. Boutros anticipates cosmetic procedures will be performed in physicians' offices as well, as technology becomes safe enough to use in the office setting.

However, Mr. Dailey doesn't think the goal for surgical procedures should be to move away from the ASC.

"We like to question (the move to an office) because there could be a liability factor involved," he says. "We prefer to keep business in the surgery center."

More Articles on Specialty ASCs:
How Does Spine Surgeon Employment Compare to 10 Years Ago? 6 Spine Surgeons Respond
Stem Cell Treatment & Minimally Invasive Spine Stabilization in Outpatient Surgery Centers: Q&A With Laser Spine Institute on New Procedures
10 Surgery Centers Focusing on Sports Medicine

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