Orthopedic Procedures in ASCs: 3 Keys to Improving Case Profitability

At the 11th Annual Orthopedic, Spine and Pain-Management Driven ASC Conference in Chicago on June 13, Michael R. Redler, MD, an orthopedic surgeon at The Orthopaedic and Sports Medicine Center in Trumbull, Conn., discussed key concepts surrounding performing orthopedic procedures in ambulatory surgery centers.

Dr. Redler began by sharing some of the challenges facing surgeons in ASCs. The biggest ones include reducing the time required to perform procedures, increasing the range of cases that can be performed in the ASC setting, and keeping implant and disposable supply costs as low as possible.

Reducing procedure time
Ensuring ORs can be turned over frequently helps improve an ASC's profitability. To ensure timely turnover, ASCs should limit the activities performed in the OR to surgery only. For example, nerve blocks should be placed before the patient is moved into the OR. Nerve blocks, instead of regional anesthesia, also reduce the time a patient spends in the post-anesthesia care unit, Dr. Redler added. "It is not only good care for the patient, but makes economic sense as well," he said.

He also mentioned the importance of marking the site (left or right extremity) that will be treated during surgery. If a procedure is performed on a wrong site, it can be detrimental for the ASC. "Wrong site surgery can be eliminated in orthopedic surgery by following best guidelines," he said.
Dr. Redler added that anesthesiologists should also mark the site of regional blocks, explaining that wrong site blocks are one of the more common types of wrong site procedures. Blocks can be started before the patient enters the OR, thereby reducing the total OR time.

Increasing range of cases

Minimally invasive techniques have greatly increased the range of orthopedic cases that can be performed in an ASC, said Dr. Redler "A lot of procedures these days that were normally done as an open procedure…now can be done minimally invasive," he said.

Spine cases have also been moving to outpatient centers, he said, adding that spine surgeons perform one- and two-level anterior cervical discectomies. The start-up costs for spine cases are high and may exceed $100,000 for a single set of equipment required for these cases. However, payment for spine cases is higher than other orthopedic cases and presents a significant opportunity for revenue generation, said Dr. Redler.

Reducing implant, supply costs
Finally, orthopedic ASC leaders must focus on keeping supply costs in check. Dr. Redler encouraged the use of volume and preferred vendor discounts. He also encouraged physician owners to come to a consensus on supplies used for each case as doing so will allow the center to purchase a greater volume (ideally of a lower-cost supply) from a fewer number of vendors.

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