The trend to outpatient surgery, risk-bearing contracts for orthopedic surgeons: Key thoughts from Dr. Louis Levitt

Louis Levitt, MD, is the vice president of Bethesda, Md.-based The Center for Advanced Orthopaedics.

Dr. Levitt will share his expertise as a speaker at the Becker's ASC 26th Annual Meeting: The Business and Operations of ASCs, Oct. 24-26, 2019 in Chicago. To learn more and register, click here. For more information about exhibitor and sponsor opportunities, contact Maura Jodoin at 

He practices at the Orthopaedic Medicine Surgery Center in Washington, D.C., and serves as a staff member at Georgetown University in Washington, D.C. Here, Dr. Levitt discusses the big trends for orthopedic surgery centers today.

Question: What is the biggest challenge for your orthopedic center today?

Dr. Louis Levitt: Orthopedic surgical centers across the nation are facing many challenges as the industry continues to shift. First, Medicare only covers partial knee replacements in the outpatient surgical setting and does not allow for other joint replacements to be performed in an ASC. This leaves a large audience forced to undergo joint replacement surgery in a hospital setting, where the cost is approximately triple what it would be in an orthopedic surgical center.

We are also continuing to address and manage patient expectations. Historically, surgery was largely debilitating and involved weeks of recovery in a monitored setting. We are striving to recalibrate patient expectations to understand that surgery can be done on an outpatient basis and that they can return home to recover oftentimes on that very same day.

Finally, the high cost of orthopedic implants is challenging given that suppliers charge ASCs the same price as hospitals. However, it costs less to perform surgery in an outpatient surgical center, and we believe this should be taken into consideration when it comes to the cost of equipment.

Q: Where do you hope to grow for the next nine months?

LL: Many physicians within The Centers for Advanced Orthopaedics are performing surgery in the outpatient setting. We hope to expand our services and provide what have traditionally been hospital-based surgeries in the outpatient setting at the ASCs where we operate, including sophisticated procedures like spinal fusions. We are also aiming to expand patient parameters to operate on patients who may be older, overweight or have serious health conditions, in cases where it is safe for the patient.

Q: How do you approach budgeting for and selecting new technology for your center?

LL: Those of us at The Centers for Advanced Orthopaedics who have ASC leadership roles are very careful and strategic when selecting new technology for orthopedic surgery centers. Since our doctors have varying levels of ownership in ASCs, we need to be more financially mindful than a hospital. However, since we have more control, we can push for new technology that we are passionate about and have more influence over what is purchased.

Q: What are your biggest payer challenges today?

LL: We as physicians understand the many benefits for eligible patients who seek treatment in an outpatient setting, including decreased risk of infection, more convenient access to care, and a quicker return home. Unfortunately, for commercial payers, the reimbursements for outpatient surgery have lagged behind the payments made for the same procedure at the hospital. Consequently, there is less incentive to move the surgery to the outpatient setting.

In the future, physicians and ASCs will be sharing risk with the commercial payers to reduce the cost of care for all musculoskeletal disease. Perhaps then, we as physicians will enjoy more cooperative effort by the payors to promote outpatient surgery.

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