What procedures are migrating to ASCs?

COVID-19 has accelerated the migration of surgeries to the outpatient setting, and many administrators expect the trend to continue. 

Six administrators spoke to Becker's ASC Review on the procedures they see moving to the ASC setting. 

Complex spine procedures 

Administrators are seeing three-level 360-degree fusions, anterior cervical discectomy and fusions, spinal cord neurostimulation, peripheral nerve neurostimulation, and interspinous process decompression shifting to ASCs.

Nate Garner. Administrator of Fort Sutter Surgery Center (Sacramento, Calif.): Spine surgeons have been performing outpatient spine surgeries such as spinal fusion and disc decompression surgery in ASCs for years now. However, there has recently been an explosion in the minimally invasive spine arena, and new products and techniques have been developed that have been implemented in the ASCs. 

Angela Laux. Nurse Administrator for Advance Spine Center of Wisconsin (Neenah): We had shown that single- and two-level cases of [360-degree fusions] could successfully be done in our ASC with excellent patient outcomes and satisfaction. Our surgeons see the value to the patient having these cases done here.

Gastroenterology procedures

Eugenio Hernandez, MD. Vice President of Clinical Affairs for Gastro Health (Miami): Endoscopic ultrasounds with [fine-needle aspiration] or biopsy can be performed safely in ASCs. We have been performing EUS at several of our ASCs, including EUS-directed liver biopsy. There are operational considerations that must be accounted for, but studies have shown that the incidence of adverse events in the outpatient setting is similar to that in hospital endoscopy units.

While there have been studies published demonstrating that [endoscopic retrograde cholangiopancreatography] can also be performed safely in an ASC setting, this would require a highly selective policy that would limit the volume of potential procedures, impacting the financial feasibility of performing ERCP in the ASC setting.

Total joint procedures

Mr. Garner: Total joint replacement surgeries have been performed in ASCs for several years now. Initially these patients may have been kept overnight to ensure a smooth recovery, but now more often than not, are being discharged home the same day. Medicare currently covers total knee and total hip replacements. Other total joint procedures being successfully performed in the ASC include total shoulder, ankle and elbow arthroplasty.

Teresa Copeland, the director of managed care for Knoxville-based OrthoTennessee, told Becker's ASC Review that total joint replacements have been the biggest movement over the past 18 months. Her facility is on track for over 1,200 total joints in 2021. 

Robotic procedures

Mr. Garner: As technologies improve and space and affordability barriers are addressed, it is likely that we will see robotic-assisted surgery become more common in the ASC for various other procedures including hernia repair, cholecystectomy, hysterectomy, prostatectomy, bronchoscopy and spine surgery.

Cardiology procedures

Mr. Garner: Positive outcomes, improved patient experience and cost effectiveness have driven this focused shift in expansion of cardiovascular services to the outpatient setting. Included in the list of cardiac procedures now being performed in ASCs in states where permissible are angioplasties, catheterizations, pacemaker insertion and loop recorder placement.

Brock Kreienbrink, MSN, RN. Administrator and Director of Nursing for the Outpatient Surgery Center of Central Florida (Wildwood): Since I am a cardiac-only surgery center, my main focus is on cardiology, and I see a huge push of cardiologists opening their own surgery centers. With the [Medicare] approval of coronary atherectomy and percutaneous coronary intervention, you should see a huge push from cardiology into surgery centers.

David Horace, the administrator and owner of Bel-Clair Surgical Center in Belleville, Ill., told Becker's ASC Review that he sees select electrophysiology procedures making the move to surgery centers because of commercial insurance company interest.

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