The big opportunities for ASCs today: 2 physician perspectives

Over the past several months ASCs across the U.S. experienced temporary closures or case drops and then recovery with the pandemic.

COVID-19 threw a wrench into the strategic growth plans for many physician groups in the ASCs, but there are silver linings as more patients, payers and physicians recognize outpatient surgery centers as the most desirable setting for quality care. During the Becker's ASC Virtual Event on Sept. 30, Frank Phillips, MD, co-director of spine surgery at Rush University Medical Center in Chicago, and T.K. Miller, MD, vice chairman of the department of orthopedic surgery at Roanoke, Va.-based Carilion Clinic, discussed the big challenges and opportunities for ASCs moving forward.

Below is an excerpt from the conversation. Click here to view the session on demand.

Q: What is your outlook for orthopedics and ASCs today? What do you think are bright spots and what are dark spots?

Dr. Frank Phillips: It's an interesting time for ASCs and we've all talked about how the COVID situation has really accelerated and driven demand to the ASCs. I think that fairly routinely patients actually now will request to have their surgeries done in ASCs rather than the quote unquote 'COVID' hospitals. I think there's a lot of demand for patients to stay out of hospitals, which they perceive as potentially risky, whether that's true or not.

There's a real awareness and demand amongst patients. In terms of what are the dark spots, for me as a spine surgeon, we're still challenged by insurance issues. Some of the procedures we do have evolved and morphed towards ASC procedures or lumbar fusions, for example, which involve a lot of hardware and biologics and are generally expensive procedures. With covered reimbursement, those are often not sustainable in an ASC environment, so I think that's sort of the dark spot.

As the ASC for spine experience grows, I think we need to work through some of the roadblocks. To me, it's a no-brainer if you were the insurance company. You're getting the site of surgery that's being shown to be safe, the ASC, for a third of the price. What's not to like? That is where things are at least from a spine lens and some of the biggest challenges we face.

Q: Dr. Miller, what are the challenges that you see, as well as the opportunities?

Dr. T.K. Miller: I think the opportunities are straightforward. There is a broad spectrum of cases that traditionally have been locked into a hospital environment. I think that the changes in the next two years with the CMS changes to the ASC payable list, we'll push that even further. I would agree that there's a disconnect between facility compensation and the cost of doing a number of the cases that are very appropriately done in that environment. We've gone back and have looked at cases to move over with commercial insurers and we're still struggling to move cases for which there's no reason from a clinical standpoint, from an outcome standpoint and from a cost standpoint not to move.

I'll use a simple one. Shoulder arthroplasty is possible in a freestanding ASC environment, but we still run into the challenge of you can't make money by volume, if you lose money on every case, it's not viable in the ASC. I think that's going to be the biggest challenge moving forward is a realistic expectation of what it costs to do a case and an appropriate reimbursement in a non-hospital environment.

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