Orthopedic ASC rejects 'sexy, exciting, crazy technology' in favor of new growth model

Andrew Lovewell joined the Becker's Ambulatory Surgery Centers podcast to talk about the future of orthopedics in ASCs and his practice's unique approach to growth.

An excerpt from the conversation is below. Note: Responses have been slightly edited for clarity.

Question: How do you anticipate orthopedics and spine will evolve in the next few years?

Andrew Lovewell: I think we're going to see a continued shift of appropriate cases to the outpatient arena. A lot of that is dictated by the federal government. We run a very large private practice orthopedic group and I still have 25 percent of my volume inpatient I cannot move outpatient due to patient appropriateness. Some of that comes down to Medicare not covering outpatient shoulder surgeries yet, which is ridiculous and unreasonable when we do every other joint [in the ASC]. We use an internal metric to determine the right place, right patient and right time.

As we get really far down the road, how much do we move to robotics and augmented reality or any type of adjunctive technologies? I would love to say we'll do as much as we can with technology or robotics with digital integration into the operating room. But that all comes with a cost, and there isn't increased reimbursement.

Technology can't just create a spiral of zero. Zero is not a good multiplier. We're going to continue down this path of trying to increase our technology-driven surgery and there's no increased reimbursement for us, so that's going to be a challenge for a lot of small ASCs. But it's also a challenge when it comes to actually providing good care. We have to ask ourselves, what's right and what's appropriate? How are you compensated for what's right? That's the conversation that needs to happen.

Q: Where are you seeing the best opportunities for growth?

AL: Our practice is a little different. Our model is very heavily in nonoperative orthopedic care. Unlike most surgical practices, we're trying to avoid surgery. We're trying to get people healthier, faster and better. We've invested heavily in weight management clinics, osteoporosis clinics and we have a virtual therapy platform that we've rolled out to patients for nonoperative care to give them access to more therapy than just in person.

We're hitting a crisis point when it comes to staffing and we're trying to make sure our patients aren't lost in the shuffle. From an ASC standpoint, that doesn't do anything to bolster the bottom line. But what it does do is guarantee patients aren't on an island and they have somebody to talk to and access to care. It eventually does create momentum from patients to say, these guys really care about value. They care about giving me stuff that is added to my care, not subtractive to my care. That to me is the big selling point; how do we create an intelligent and digital front door, and widen the funnel to get more patients access to our services. If it's a surgical patient, how do we get them through the pre-cert and pre-approval or predetermination process with the insurance companies as quickly as possible, and as reasonably as possible to get them to surgery and back doing what they want to do.

That's how we plan to grow. It's not going to be the sexy, exciting, crazy technology companies, but it's continuing to deliver value at every step of the care continuum in the musculoskeletal and orthopedic space for our patients.

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