Adam Berry, CEO of Summit Orthopedics, joined Becker’s to discuss the biggest sticking points Summit has faced as more orthopedic procedures shifted from hospitals to ASCs and how the organization worked with plans and associations to clear the path.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Can you talk about the biggest friction points with hospitals that have occurred in the overall migration of procedures to the ASC setting and how Summit overcame them?
Adam Berry: When we started doing ASCs back in 2014 — and when we began doing total joints — one of the big friction points was that health plans didn’t have the contracts in place. We’re now more than a decade beyond that, so it’s less of an issue, but the way we solved it at the time was through bundled agreements. We actually guaranteed cost savings to the health plans, which was a unique element of what we did around 2012 to 2014 as we built those contracts.
Then, fast-forward to around 2018 when we were building another facility: the biggest impediment was the inpatient-only list — the codes that were allowed only in the inpatient setting and not in the ASC. As you probably know, the last of the inpatient-only restrictions for musculoskeletal saw a major transformation this November, so that’s largely no longer the friction point. We addressed it by continuing to lobby and work through trade associations to help ensure the inpatient-only list went away.
Another friction point that came up at various times with some payers was concern about utilization. If you take what was otherwise an inpatient procedure and move it to an outpatient procedure, they may see a lower cost per case — but they worry the number of cases will increase.
Even if they’re paying 20% less to do it in an ASC versus a hospital, they may think an ASC is so much more efficient that you’ll do 30% more procedures. We were very intentional about sitting down with the medical directors at these plans and showing them, consistently, our standardized treatment algorithms and our conditions and indications for surgery — and that we were not changing them. That helped them get comfortable that we weren’t manufacturing volume that wasn’t there before.
