Greg DeConciliis, PA-C, CASC, an administrator and physician assistant at Boston Out-Patient Surgical Suites in Waltham, Mass., describes four trends in outpatient orthopedic surgery.
1. Higher acuity cases. Mr. DeConciliis says there has been an increase in higher acuity orthopedic cases in the outpatient setting. Complex ligamentous knee reconstructions, partial knee replacements, total knee replacements and spine procedures can now be done safely and effectively in an outpatient basis, according to Mr. DeConciliis. In addition, many procedures have become less invasive, which makes them ideal for ambulatory surgery centers. He says insurance companies are beginning to recognize the cost savings of having certain procedures performed in an ASC rather than a hospital, and are reimbursing accordingly. They have been willing to work with ASCs to provide adequate reimbursement for these procedures as it will still cost them less compared to the hospital.
2. Hip scopes. More physicians are performing hip arthroscopies, Mr. DeConciliis says. Medicare recently recognized additional codes for the scopes, which has provided additional reimbursement for physicians and ASCs. These cases can now be performed consistently without a loss.
3. Regional nerve blocks. Outpatient centers have been using more regional nerve blocks, according to Mr. DeConciliis. Boston Out-Patient Surgical Suites purchased an ultrasound machine to help anesthesiologists perform blocks quicker and easier while using less medication. "It was a significant capital investment, but it paid dividends a hundred fold," Mr. DeConciliis says.
In addition, regional nerve blocks allow anesthesiologists to use fewer narcotics inter-operatively, which results in less nausea and vomiting for patients post-operatively. This allows patients to move more quickly through the recovery room, which frees up room for other patients. "There is a hesitancy [among surgeons] because the time it takes between procedures to do a nerve block slows things down. But it's a trade-off because at the back end you're moving patients through the facility a lot quicker," Mr. DeConciliis says.
4. Implant reimbursement. ASCs are receiving more adequate reimbursement for procedures involving implants, Mr. DeConciliis says. Insurers are either willing to pay for implants or increase reimbursement for CPT codes that have implants. Increased reimbursement has allowed Boston Out-Patient Surgical Suites to perform shoulder cases using implants, for example, as these were cases that typically had associated high costs secondary to implants. A key to successfully receiving adequate reimbursement for procedures containing implants requires someone at the facility to first identify which procedures have implants and cost too much to perform at the ASC and then develop tactics to approach insurers on reassessing reimbursement. Mr. DeConciliis suggests educating insurers. "One of the keys is meeting with insurance companies at the facility. Go through case costing techniques to show them exactly what things cost and how much you are losing on these procedures with implants." Meeting with insurance companies allows ASCs to renegotiate with insurers — as for the most part they are all aware of ASCs and how much cost savings ASCs can provide for them — and meet their needs at the same time. "They are all willing to work with you," Mr. DeConciliis says.
Learn more about Boston Out-Patient Surgical Suites.
1. Higher acuity cases. Mr. DeConciliis says there has been an increase in higher acuity orthopedic cases in the outpatient setting. Complex ligamentous knee reconstructions, partial knee replacements, total knee replacements and spine procedures can now be done safely and effectively in an outpatient basis, according to Mr. DeConciliis. In addition, many procedures have become less invasive, which makes them ideal for ambulatory surgery centers. He says insurance companies are beginning to recognize the cost savings of having certain procedures performed in an ASC rather than a hospital, and are reimbursing accordingly. They have been willing to work with ASCs to provide adequate reimbursement for these procedures as it will still cost them less compared to the hospital.
2. Hip scopes. More physicians are performing hip arthroscopies, Mr. DeConciliis says. Medicare recently recognized additional codes for the scopes, which has provided additional reimbursement for physicians and ASCs. These cases can now be performed consistently without a loss.
3. Regional nerve blocks. Outpatient centers have been using more regional nerve blocks, according to Mr. DeConciliis. Boston Out-Patient Surgical Suites purchased an ultrasound machine to help anesthesiologists perform blocks quicker and easier while using less medication. "It was a significant capital investment, but it paid dividends a hundred fold," Mr. DeConciliis says.
In addition, regional nerve blocks allow anesthesiologists to use fewer narcotics inter-operatively, which results in less nausea and vomiting for patients post-operatively. This allows patients to move more quickly through the recovery room, which frees up room for other patients. "There is a hesitancy [among surgeons] because the time it takes between procedures to do a nerve block slows things down. But it's a trade-off because at the back end you're moving patients through the facility a lot quicker," Mr. DeConciliis says.
4. Implant reimbursement. ASCs are receiving more adequate reimbursement for procedures involving implants, Mr. DeConciliis says. Insurers are either willing to pay for implants or increase reimbursement for CPT codes that have implants. Increased reimbursement has allowed Boston Out-Patient Surgical Suites to perform shoulder cases using implants, for example, as these were cases that typically had associated high costs secondary to implants. A key to successfully receiving adequate reimbursement for procedures containing implants requires someone at the facility to first identify which procedures have implants and cost too much to perform at the ASC and then develop tactics to approach insurers on reassessing reimbursement. Mr. DeConciliis suggests educating insurers. "One of the keys is meeting with insurance companies at the facility. Go through case costing techniques to show them exactly what things cost and how much you are losing on these procedures with implants." Meeting with insurance companies allows ASCs to renegotiate with insurers — as for the most part they are all aware of ASCs and how much cost savings ASCs can provide for them — and meet their needs at the same time. "They are all willing to work with you," Mr. DeConciliis says.
Learn more about Boston Out-Patient Surgical Suites.