Orthopedic surgeons think ASCs are saving the specialty amid high consolidation and the movement to value-based care. Can ASCs also save healthcare?
Orthopedic surgeons have the reputation of wanting to remain autonomous and operate their own practices instead of becoming hospital employees. As the costs and risks associated with owning physician practices increased during the pandemic, surgeons who had surgery center ownership were in a better position to stay independent because they had the additional revenue stream.
"Along that concept of physician interest, the ASC may promote increased surgeon autonomy in their practice," said Kern Singh, MD, co-director of the Minimally Invasive Spine Institute of Midwest Orthopaedics at Rush in Chicago. "As large hospital systems continue to expand through acquisition of private groups, the autonomy of the surgeon in the hospital faces increasing resistance. Surgeon ownership of outpatient surgical centers provides an avenue for enterprising physicians to take ownership of their patient care and collections with less administrative resistance."
The effect of consolidation on access to care and price of care is well-documented. In markets with fewer independent physicians and provider options, prices are higher, and there is less access to care. Communities with more independent physicians and multiple options for care typically have lower healthcare costs and insurance premiums to stay competitive. Patient satisfaction is also higher in markets with less consolidation.
The surgery center is also becoming a more valuable component of the healthcare system because overall cost of care is lower at ASCs than hospitals, and in some markets insurers and employers are driving cases there. The movement could be expedited by a focus on risk-based contractive and value-based care.
Patients who undergo the less invasive surgical techniques in ASCs have less of their anatomy disrupted and are more likely to recover quickly.
"The most important trend at this time in healthcare saving orthopedics is the transition to outpatient surgical care whenever feasible," said Niranjan Kavadi, MD, a spine surgeon in Oklahoma City. "Traditionally, open musculoskeletal procedures have been associated with postoperative pain interfering with rehabilitation. Minimally invasive techniques to achieve excellent outcomes are evolving rapidly with an advantage of less surgical morbidity and quicker rehabilitation."
Dr. Kavadi went on to say many procedures leaving the hospital setting for ASCs allows inpatient units to focus on sicker patients; moving procedures to ASCs can also have a positive psychological impact on patients as they undergo outpatient rehabilitation and a return to daily activities, because they are returning home right after surgery and the recovery timeline is accelerated.
ASCs running lean operations could also force the medical device and supply industry to compress prices so higher acuity procedures are also cost-effective in the ASC. Insurers are pushing cases there, but ASCs won't be able to make the margins work unless vendors are also willing to negotiate prices.
"From a financial perspective, the ASC delivers the clear benefit of avoiding the expenses associated with inpatient admission to the hospital, affording insurance companies and providers considerable savings," said Dr. Kern. "In addition, the ASC increases the financial interests of physician owners, providing a clear incentive to save on operative costs via process standardization, which may in turn facilitate a favorable reduction in the price of surgical implants."
It seems like ASCs should be in a perfect position to capitalize on the move to high quality, low cost care. But without favorable insurance policies and the same boost the federal government gave to hospitals to incorporate sophisticated technology needed for value-based contracting, surgery centers are still often on the outside looking in at big healthcare decisions.