With advancements in medical technology and high-quality outcomes, CMS has steadily allowed more orthopedic procedures to be performed in outpatient settings such as ambulatory surgery centers.
Yet growing a profitable orthopedic program can be a challenge.
During a December Becker's Hospital Review webinar sponsored by National Medical Billing Services, experts discussed strategies for making orthopedics successful at ASCs. Speakers were:
- Kylie Kaczor, MSN, RN, senior vice president, clinical and regulatory affairs, National Medical Billing Services
- Aaron Davis, vice president, client operations, National Medical Billing Services
- Bill Hazen, RN, CEO, Surgery Center at Pelham (Greer, S.C.)
Four key takeaways were:
1. Consumer, payer and surgeon sentiment are driving the growth of ASC-based orthopedic procedures. For surgeons, ASCs may offer a more appealing environment in terms of scheduling and staffing than hospitals, and ASCs provide opportunities for equity ownership. For payers, ASCs represent significantly lower costs than the same procedure in hospitals, which is a factor too for consumers, who are increasingly paying huge deductibles. “Patients and consumers are accustomed to having transparency and to have control over their costs,” Mr. Davis said. Patients also like ASCs because of the convenience, personalized attention, shorter length of stay and safety. "Patients just do not want to go back into the hospital setting," Mr. Hazen said.
2. Clinical and regulatory conditions favor ASCs for many orthopedic procedures. Many orthopedic procedures are safer in ASCs, as they have a lower rate of post-procedure infections. ASCs have had orthopedic procedural advances involving technology and clinical standards. These have included advancements in pain management techniques, minimally invasive surgical techniques, ambulatory patient care pathways and improved treatment protocols.
"There seems to be this general focus on orthopedics in particular by CMS and lawmakers, recognizing that advances in medicine and technology are making it possible to continue to support this migration [from hospitals to ASCs]," Ms. Kaczor said. That's helped drive CMS to move more orthopedic procedures to the outpatient list over the last seven years. Meanwhile, the increasing Medicare population and COVID-19 have strained hospitals' capacity.
3. Selecting the right patients for ASC surgery helps build on ASCs' orthopedic success. To help drive favorable outcomes, an ASC's care team must ensure that each patient is a good candidate for surgery in an ASC and is well educated about the procedure, process and recovery. “The safety measure of selecting the correct patient and establishing highly defined treatment protocols is the best approach an ASC can take for tracking outcomes,” Mr. Hazen said.
4. Operational processes are critical for ASC success. Key critical processes to review are contracting, front-end processes, including financial counseling and patient education, and real-time cost accounting, as well as coding, claims and other aspects of revenue cycle management. “Cost accounting is crucial…you really have to get everyone on the same page" Mr. Hazen said. Another critical aspect of the revenue cycle is having airtight processes for insurance verification and doing the paperwork ahead of time. "With orthopedics and more implant-intensive cases, authorizations are absolutely critical, as is understanding your payer structure and who requires [authorization]," Mr. Davis said.
Although mounting costs make profitability challenging for ASCs, there are several considerations ASCs can implement to grow a strong orthopedic program. Keys to success include selecting the right patients, having the right tools, tight processes, and an experienced team in place.
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