Trends ASC execs are skeptical of right now

There are many reasons for ASC owners and operators to be optimistic. Patients and payers are demanding outpatient surgery, employers are seeking direct contracting opportunities with surgery centers, and ASCs proved a vital resource for elective surgery during the pandemic.

But there are still issues putting ASC administrators on edge. From new technology purchasing to surgeons taking increasingly complex cases to the ASC, several emerging industry standards are making owners and operators wary.

"The trend that causes me a little heartburn is that higher acuity surgeries are being performed at ASCs with tremendous velocity," said Samir Patel, MD, president and CEO of the Institute for Orthopaedic Surgery in Lima, Ohio. "The move is encouraged now by commercial payers and CMS for cost savings and welcomed by ASC owners for expanded revenue. I'm fearful for the inevitable increase in complications as a result of hastened care."

A new push for adopting robotics in orthopedic surgery has some owners and administrators befuddled. The equipment adds costs, and initially time, to orthopedic surgeries without always demonstrating better outcomes. That combination could be lethal to surgery centers operating on thin margins.

"I think one of the biggest dubious trends affecting ASCs would be the push for robotics in joint replacement," said Richard Steinfeld, MD, of the Orthopaedic Center of Vero Beach (Fla.). "The push is primarily from industry, is associated with extremely high cost and is not definitively associated with clinical benefit. This appears to be a marketing push from total joint companies to gain volume and market share as these cases are moving to the ASC setting."

Healthcare industry experts have predicted value-based care and bundled payments will become the norm for the last decade, but few initiatives have been effective. Most care remains fee-for-service with little incentive to change. Jarett Landman, CEO of the Orthopedic Surgical Center of the North Shore in Peabody, Mass., is skeptical that payer methodology will ever change.

"While I am an ardent believer in cost transparency and care collaboration, it seems implausible that we can move from fee for service to fee for value in the near term," he said. "Grading successful outcomes and tying them to financial values is intrinsically difficult, and this is only heightened by the financial malalignments between payers, providers and facilities. My guess is we are a ways off from ever seeing widespread adoption of this payment methodology."

Cheri Smith, a former ASC administrator of St. John's Surgery Center in Fort Myers, Fla., also sees tension in how the ASC market will grow. Private equity and other large corporations are identifying the value of ASCs and making quick investment deals. Some in the industry see more capital flowing into surgery centers as a positive step toward growth, but Ms. Smith is nervous that ASC leaders' attention could shift from quality of care to volume-driven financial success.

"If managed properly, ASCs can satisfy both [quality and financial standards]," said Ms. Smith. "In speaking with fellow colleagues, including physicians who are often the first to relinquish control as organizations shift from private to corporate, this model has been exercised in decades past with more unforeseen failures as opposed to successes. Is history doomed to repeat itself? May the physician and the patient never find out."

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