Strategy for ASCs to Acquire Advanced Equipment Without Breaking the Bank: Q&A With MALO ASC's Joseph Testani

MALO Center for Ambulatory Surgery signed an agreement with CONMED earlier this year for the exclusive rights to its 3DHD Vision System. MALO ASC is the only ambulatory surgery center in the country with the technology, designed for more accuracy during endoscopic procedures. Chief Administrative Officer of MALO ASC Joseph Testani discusses why the center acquired this new technology and where he hopes it will take them in the future.

Q: What was your strategy for incorporating the 3DHD Vision System into your center? Why did you think it would make sense?

Joseph Testani: We are a new ambulatory surgery center with a multispecialty focus, and we're planning to be above 80 to 85 percent in-network. Part of our reasoning for moving forward with this technology was to entice our bariatric, gynecology and urology physicians with the ability to treat patients with minimally invasive procedures using this new, advanced technology. Surgeons are able to actually treat and diagnose patients at a higher level with the new equipment.

This is something you would typically see in a robotic setting, which is much more common in a hospital setting because it's cost-prohibitive in the ASC. However, we wanted to allow patients to have access to the same level of quality care and advances in technology in the ambulatory setting as more procedures move to the outpatient arena.

Q: What type of research did you do before purchasing the equipment? Are there any special considerations for a multispecialty facility like yours?

JT: We did some pre-analysis on the technology in the operating room and allow for physicians to use the system and see its advantages, both from their perspective and the benefits to the patients. CONMED has been very active in teaching our physicians about using the technology in the outpatient setting. We invite other physicians to come and observe how we use this on patients and how this technology could benefit them and their patients. Depending on the physician's familiarity with the stereotactic and minimally invasive work — whether they've used the da Vinci robot or other similar equipment — they can enhance their expertise rather quickly. If the clinician isn't familiar with these advances, it might take longer to train.

Q: How are patients able to benefit from this technology in the outpatient setting? Is it really worth the extra cost?

JT: The equipment allows for a much quicker recovery and the cost for a traditional ASC procedure is lower than in the hospital. Additionally, infection rates are lower and patients return home more quickly. This technology has proven effective during bariatric, gynecology and urology procedures and hopefully it will radiate to other specialties as well. There are some spine procedures that can utilize this technology. As a result, we don't need as many towers in our center because we can use the same one for bariatric, urology, gynecology and orthopedic procedures.

We've cut down on the amount of capital purchases to accommodate for the multispecialty. Additionally, our relationship with CONMED gave us a price structure to bring the equipment into the ASC. With robotic technology, it would still be a heavy financial burden. However, this system hasn't been very costly.

Q: Insurance companies don't typically reimburse more for procedures using new or technologically advanced equipment, such as robotics. Does this technology fall into the same category? How can the center see a return on investment?

JT: The reimbursement side of healthcare does not allow us to upcode in order to recapture that cost. Therefore, expensive equipment like robotics is very cost-prohibitive when used. Since we aren't talking about that type of price tag, and because multiple specialties in our center are able to use it, it allows us to treat patients at the same level as in the hospital but at a reimbursement rate that is palatable for its expense.

It's in the best interest of any forthcoming technologies looking to move into the ambulatory setting to understand a pricing and reimbursement structure that allows those dollars to be recouped. That way, the technology isn't just a marketing tool, but an efficient way of delivering healthcare. It isn't fairly reimbursed for its outlay of dollars, but that's the challenge we face throughout the healthcare environment.

Q: Do you think the cost will be very prohibitive for ASCs trying to bring in new technology in the future?

JT: It's necessary as we move forward with the changing healthcare environment for the ASC world to open up to new technology. We can tell payers how it reduces length of stay, changes outcomes for its members and reduces recovery times; therefore, the technology should be reimbursed higher to allow for the reduced costs.

Q: How will this technology benefit your center in the future? Do you see ASCs purchasing this type of equipment become more of a trend now that you've broken the ice?

JT: Studies show the technology reduces error rates and leads to a more efficient, accurate and quicker recovery. The healthcare trend now is taking procedures from the inpatient to the outpatient setting, so I think it's important to provide patients with the same quality of technology offered in the hospital. Patients tend to believe they can only get certain types of quality surgery in the hospital setting, and not in the outpatient surgery center. We want to change that perception.

We are beginning to see a new focus on costs, and in the future the healthcare system will have to meet patient demands with higher deductible plans and different types of insurances while still curtailing costs. As we move toward that type of care in the United States, it will be essential to have this type of technology available in a more cost-contained environment than the hospital.

Surgery centers that are in the business of being state-of-the-art and on the forefront of delivering high-quality care, and that have the right specialists, will invest in the technology to make outcomes the best they can be. We're a four-room ASC with several specialties, and it may not make sense to acquire this technology in a smaller center with limited specialties. However, if you can accommodate 23-hour stays, have pediatrics and adult surgeries and multispecialty physicians, I think the business strategy of awarding technological advances to surgeons and patients works.

Q: Do you feel this particular technology will stick around for several years to make the investment worthwhile? What happens when newer technology comes on the market?

JT: Technology will always advance. As an outpatient provider, we need to assess the standards of any new technology academically. For me to run a center of excellence, I need to have high-quality physicians as well as the latest technology. CONMED has done a great job of making the technology available and not cost-prohibitive for entities that are for-profit. They aren't just limiting or pigeon-holing this to the hospital arena.

The healthcare industry must constantly challenge itself to advance academically and technologically for the betterment of our patients and outcomes. That should not only take place in the teaching hospital setting, but also go to its extenders. It's my philosophy that this ASC will be an extender in excellence in teaching and at the forefront of technology.

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