CMS has approved a growing list of procedures for the ASC setting in recent years, particularly in cardiology, and that shift is reshaping which specialty lines ASC operators are betting on for growth.
Terry Bohlke, CEO of Nashville, Tenn.-based Keystone Surgical Partners, spent 10 years as the senior executive overseeing ASC operations, quality, finance, acquisitions and development at Franklin, Tenn.-based Community Health Systems before launching Keystone this year.
Here is his specialty-by-specialty outlook for where ASC growth is headed over the next five to 10 years.
1. Nearly every specialty is profitable in an ASC. Mr. Bohlke said the setting’s efficiency outweighs its lower reimbursement rates compared with hospitals.
“It’s hard to not make money on a specialty in an ASC, not because we get paid a whole lot; we get paid way less than half for Medicare, but way less than half for commercial payers, too,” he said. “But we are so efficient, incredibly efficient … just about everything [can be] profitable.”
2. Cardiology and cardiovascular procedures are the biggest near-term growth areas. Mr. Bohlke pointed to CMS’ steady expansion of approved procedures in those specialties.
“Medicare just keeps approving more and more procedures in those specialties, and they do well,” he said. “And there’s a lot of them. And of course, they’re primarily Medicare, so those are great cases.”
3. Spine surgery is nowhere near its ceiling. Mr. Bohlke said single-specialty spine centers are emerging as a bright spot.
“Spine hasn’t even begun to meet its capacity in ASCs. There’s just a lot of room for spine cases, a lot of cases that could be done,” he said. “We’re seeing a lot of spine-only, single-specialty spine surgery centers that are popping up and doing extremely well.”
4. Orthopedics, especially total joints, has significant room to grow. An aging, more active population is driving demand, Mr. Bohlke said, and ASC capacity has not caught up.
“Orthopedics continues to grow with the aging of the population, the more active population,” he said. “The number of ASCs doing total joints is really small relative to the opportunity of total joints that are out there, so that’s going to be a huge growth area.”
5. Urology can thrive in an ASC, but it takes a practice shift. Mr. Bohlke said groups that commit to moving surgical cases out of the clinic and into the ASC setting are seeing strong results.
“I’ve seen a lot of growth in urology,” he said. “They do so many cases in their practice at the clinics that really do a lot better in the ASC environment. If a urology group has a sufficient number of cases and they’re committed to change their practice to where they see those surgical cases in the ASC, they can actually be very successful. Even a single-specialty urology ASC can do very well if they follow that guidance.”
6. GI remains strong, shaped by colonoscopy age shifts. Mr. Bohlke helped analyze data from GI IT company Provation comparing colon cancer detection rates in the 45-to-55 and 55-to-65 age cohorts.
“The detection rates were the same,” he said. “So what that says is, by lowering the age, it kept the same amount of detection rate, which means it was a great move to lower that age. That then calls into question: Should we lower it more? Can we save more people from colon cancer by reducing that age again?”
7. Pain management, particularly spinal stimulators, is a growing niche. Mr. Bohlke said the devices fit his broader view of surgery: Use them when needed, avoid them when possible.
“Pain management, still very good, very important, particularly spinal stimulators,” he said. “I’m very pro spine surgery, but I’m also pro keeping people out of surgery if they don’t need it, and spinal stimulators can do that. I think those are growing as well.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
