ASCs return to growth: Big plans from innovative execs

ASC owners and administrators have a new outlook on growth and expansion one year after the pandemic began.

For many centers, 2020 meant lower case volume and revenue because elective surgeries were limited. But the crisis also pushed administrators to adopt more innovative strategic plans and drove more procedures outpatient.

"Over the past year we have become much more forward looking in our [decision-making] approach," said Matthew Ewasko, administrator of Physicians Alliance Surgery Center in Cape Girardeau, Mo. "Prior to the pandemic, we looked more at historical trends and possible one to two months in the future when considering decisions for the facility. Now we are looking at least three months, if not more, in the future when we are considering changes or purchases."

Mr. Ewasko said his center also began focusing more on the patient experience and invested in technology for a more contactless process. The center now has online patient registration and bill pay capabilities.

"This has expedited the payment process for us, while making it much simpler for our patients who don’t want to write a check or give credit card information over the phone," he said.

Vincent Hayes, COO of Bradenton-based Florida Digestive Health Specialists, said remaining a private practice instead of joining a hospital or accepting private equity investment allowed the center to quickly react during the pandemic.

"In 10 years, we've expanded from 23 providers to more than 80 and from just a handful of offices to 26 clinic locations," he said. "When COVID-19 hit, our teams selected and launched a new telemedicine system in one weekend. And while other health systems cut physician salaries, we onboarded seven new gastroenterologists and opened two new clinics. We're able to keep operational costs low, streamline administration tasks and use our large market share to negotiate better reimbursement rates."

Mr. Hayes anticipates his group will continue expanding its presence in markets where there is a need and recruiting physicians who thrive on professional autonomy and ownership.

Orthopedic centers in many communities experienced an increased demand for operating room space as hospitals limited elective surgeries while focusing on COVID-19 patients. In some communities, surgeons took patients to the ASC for the first time and aim to continue performing cases there. CMS changes are also driving volume growth.

The Orthopaedic Surgery Center in Youngstown, Ohio, opened in 2020, and its owners are already thinking about facility expansion.

"We've done a very good job in recruiting physicians and expanding service lines," said Taylor Cera, COO of Orthopaedic Surgery Center. "CMS continues to change and potentially steer volume toward the outpatient ASC setting by allowing more procedures to be done in an ASC setting. Total knees were allowed in 2020 and total hips in 2021, and if CMS puts total shoulder arthroplasty on the ASC fee schedule, that will further expand our orthopedic service line. In order to maintain efficiency, we are considering expanding our operating rooms."

Advanced Ambulatory Surgery Center in Redlands, Calif., built four extended recovery suites last year to mirror a hospital suite.

"This allows our spine and joint patients the comfort and privacy to recover from their surgery, allows for a family member to stay with them and have the benefit of being coached one-on-one by one of our experienced spine and joint nurses, so they know how to care for their family member upon discharge," she said.

Adding service lines and new technology can also attract surgeons to bring their cases. Larry Parrish, administrator at Illinois Sports Medicine & Orthopedic Surgery Center in Morton Grove, said his center began examining robotic technology before the pandemic and plans to acquire a surgical robot this year, even though not all of the center's current total joint surgeons will use it.

"We do believe that having robotic technology will be an asset in recruiting new joint replacement surgeons who trained with this capability, which will enhance the growth of our already well-established program," he said.

There are also new opportunities emerging for ASCs to drive patient volume by competing on pricing. ASCs can have 35 percent to 40 percent lower overall prices than hospitals on average, said Christina Goodall, RN, DNP, administrator of Atlanta Orthopedic Institute, which is attractive to payers. There are also new opportunities with self-insured employers.

"ASCs that have an ability to bundle their services for specific procedures will have the opportunity to negotiate directly with self-insured employers, enabling their employees to get concierge-type services at reduced rates. By doing so, employers will reduce their loss time injuries and ensure that their employees receive high quality services in a controlled environment," said Dr. Goodall.


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