The rise of orthopedics in ASCs

Orthopedics is the most common specialty for ASCs in 2022, according to March data from the ASC Association.

Here are insights from two CEOs and an orthopedic surgeon on what orthopedics has to offer ASCs and why the specialty has been so successful in the surgery center industry.

Editor's note: Responses were edited lightly for clarity and brevity.

Michael Boblitz. CEO of Tallahassee (Fla.) Orthopedic Clinic: Spine and joint replacement services have historically been performed predominantly in the hospital setting mingled with the wide range of surgical specialties that span well beyond orthopedics. At Tallahassee Orthopedic Clinic, these services now reflect 75 percent [of cases] plus outpatient case mix.

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John Ryan. CEO of OrthoIndy (Indianapolis): Among several challenges for ASCs, I think the three most significant are procedure volume, payer contracting and case mix. Any one of these three challenges can mean the difference between an ASC that is successful and one that fails. I am no doubt biased, but orthopedics is a single solution to address all three of these challenges. Regarding procedure volume, predictive modeling in demographics points to a population boom of those seeking orthopedic care, so we know that orthopedic procedures will be a meaningful source of ASC case volume growth in the future. We also know that more and more orthopedic procedures are migrating into the outpatient setting from the inpatient setting, providing yet another source of growth in ASC procedure volume opportunity. Regarding payer contracting and case mix, a few thoughts come to mind.

First, reimbursement for orthopedic cases could always be better, but as reimbursement goes, it is better than several other specialties, making it an attractive specialty to offer at an ASC. Related, I am likely stating the obvious when I say that ASCs with meaningful orthopedic volume stand a much better chance of financial viability and sustainability than those [without]. While it is absolutely possible for an ASC to be financially successful without orthopedics, those ASCs with orthopedic procedure volume at or above 25 percent have a far clearer path to navigate the other economic pressures on an ASC's financial health.

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Alexander Sah, MD. Orthopedic surgeon in Fremont, Calif.: So the nice thing about when orthopedic surgeons work closely with ASCs to provide this specialty care is that you can provide much better and efficient orthopedic care, because you're not distracted by the other challenges of the main hospital. So in the main hospital, you're going to have other surgeries, you're going to have emergencies, you're going to have shortages of staff, people are going to get pulled in different directions.

But the movement of orthopedics to ASCs is almost creating a specialty-like hospital so that you could really fine-tune the care to that specific procedure so that you can do more cases more efficiently, more safely for the patients and have better overall outcomes. So that's where that partnership between surgeons and ASCs have an opportunity to continue to grow.

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