Cardiac procedures are the 'total joints of tomorrow' for ASCs — 3 Qs with Outpatient HealthCare Strategies' Jessica Nantz

Total joints and cardiac procedures are two of the biggest opportunities for ASCs in 2019, according to Jessica Nantz, president of Spring, Texas-based Outpatient HealthCare Strategies.

Here, she shares additional insights on challenges and future growth areas for ASCs.

Note: Responses have been lightly edited for clarity and style.

Question: What is the biggest growth opportunity for ASCs in 2019?

Jessica Nantz: The biggest opportunities for growth concern launching total joint replacement and cardiology programs or, if an ASC already has such programs, adding more total joint replacement and cardiology procedures.

In the past few years, we have seen an explosion of ASCs performing total joint replacements, as demonstrated by this list of some of the ASCs with total joint replacement programs. Surgeons have become more proficient with minimally invasive techniques, which has increased the number of patients who can safely receive a total joint replacement in an ASC. Third-party payers, appreciating the cost savings that can be achieved without a loss of quality (and sometimes an improvement) by moving these cases into ASCs, are increasingly embracing ASC total joint replacement programs by providing fair reimbursement and expressing a willingness to explore alternative payment models, such as bundles.

Furthermore, recognizing the burgeoning market for ASC total joints, medical device companies are launching ASC-focused total joint divisions, which are developing new, cost-efficient technologies. Those companies that have catered to the ASC total joint market for some time are acknowledging the need to lower their device costs to remain competitive, thus making it easier for ASCs to launch and grow a program.

Cardiac procedures are thetotal joints of tomorrow for ASCs. In the final 2019 payment rule, a revision by CMS of the definition of 'surgery' resulted in the addition of 12 cardiac catheterization diagnostic procedures to the Medicare ASC payable list. CMS also added five other procedures often performed alongside those cardiac catheterization procedures.

While some ASCs are already performing cardiac procedures, the final rule provides further support for migrating select cardiac procedures out of the hospital and into the ASC. With private payers showing an appetite for covering these types of procedures, we anticipate seeing a surge in the number of ASCs — particularly those that are more innovative and aggressive — performing more cardiac procedures as CMS adds even more of them to their approved procedure list in the coming year(s).

Q: What are the greatest challenges you expect to face in 2019?

JN: A significant challenge that needs more attention is replacing operating room circulators and scrub techs. There have been shortages of both positions in many parts of the country. For some markets, recruiting these positions is becoming increasingly difficult.

As the shortage grows and demand climbs, ASCs will need to allocate more time and resources toward recruiting for these positions. Doing so may require looking outside their market for strong candidates, which creates its own challenges. To entice someone to relocate will likely require a very competitive offer that may need to include a signing bonus, covering relocation costs and a higher salary than previous employees received. At a time when expense control is a high priority for many ASCs, such an investment may be difficult.

Q: How do you see the ASC industry growing in the next five to 10 years?

JN: A case can be made that 2018 was one of the better years for ASCs, with the final rule delivering multiple wins. Hospitals, health systems, management companies, payers and private equity are targeting ASCs for acquisition and/or investments. Surgery centers find themselves in a very strong position in the broader healthcare market.

Growth will primarily come from the continued migration of higher-acuity patients into ASCs. If a procedure can be safely performed in a surgery center, it should be performed in a surgery center. Such a mentality — embraced by progressive surgeons and ASC leadership — has been the driving force behind the movement of so many spine, gynecology, total joint and cardiac procedures into ASCs.

As surgeons further strengthen their skills and develop new approaches to surgery, and as medical device companies launch new technologies to support or even create advanced surgical approaches, we can expect to see procedures that no one imagined could be performed outside of a hospital eventually becoming commonplace in ASCs.

To participate in future Becker's Q&As, contact Rachel Popa at

For a deeper dive into ASC industry trends, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-15, 2019. Click here to learn more and register.

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