Philip L. Schneider, MD, is an orthopedic surgeon practicing at The Centers for Advanced Orthopaedics in Chevy Chase, Md. Here, he shares his thoughts on the growth in ASCs.
Note: Responses have been lightly edited for style and clarity.
Question: What is the No. 1 opportunity you see for ASC growth?
Dr. Philip Schneider: A key growth area in the ASC setting will be the ability to perform more complex surgeries, such as hip replacements, knee replacements and shoulder replacements, as well as anterior cervical discectomy and fusion, cervical disc arthroplasty, lumbar fusion and some interspinous process fixation procedures.
The ASC at which I operate is placing a major focus on complex surgeries, and our case volume is increasing rapidly in this area. This increase is fueled by Medicare changes from inpatient to outpatient status for these procedures, and it’s also becoming more feasible to take on complex surgeries in the ASC setting with better multimodal analgesia and perioperative preparation.
Q: What do you think could impede ASC growth?
PS: Not all complex procedures should be done in an ASC. If the push toward outpatient surgery is too aggressive, it is possible that complication rates, emergency department visits and inpatient admissions could increase, reflecting negatively on ASCs as a whole. While this is not the case currently, we need to be mindful of this and make good, rational decisions on our site of service to continue steady growth.
Q: Are there any steps you're taking at your ASC to capitalize on trends or protect from potential threats?
PS: At the ASC in which I operate, we are investing in capital equipment to enable more complex surgeries. We have also developed standardized protocols to manage these patients, including preoperative assessment, home visits, perioperative pain and physical therapy protocols, as well as postoperative management. We will also be instituting patient-reported outcomes for the ASC patients.