Orthopedics in ASCs: The key trends to drive success in 2019 & beyond

Michael Redler, MD, is a founding partner of The Orthopaedic and Sports Medicine Center in Trumbull, Conn.

Here, he discusses the big trends for ASCs today and best opportunities for the future.

Dr. Redler will share his expertise as a speaker at the Becker's ASC 26th Annual Meeting: The Business and Operations of ASCs, Oct. 24-26, 2019 in Chicago. To learn more and register, click here. For more information about exhibitor and sponsor opportunities, contact Maura Jodoin at mjodoin@beckershealthcare.com. 

Q: What healthcare trends are game-changers for ASCs today?

Dr. Michael Redler: We all know spine and total joint cases in ASCs are increasing. Orthopedics has been very noteworthy. Some centers have started doing minor cardiac cases as well. You are going to get to the point where there will be very few cases that will require long hospitalizations.

The next outpatient trend will be taking on risk. As the healthcare market continues to mature, certain centers will play a great role in risk-based contracts. If a surgical center is working in conjunction with the physicians to help care for a patient population and if you own part of that risk to manage the health of the population, procedures will naturally be done at the outpatient surgery center.

I think surgical centers and partners that are part of a mature ASC can offer a broad range of services and low complication rates. These centers will be the low-cost partner that insurance companies seek out to share in the risk. They can deliver low cost of care and a low infection rate. Risk-based payment models will be well-situated to put ASCs and ASC companies in the driver's seat.

Q: Where do you see the biggest opportunity for ASCs to thrive in the next five years?

MR: ASCs are the low-cost alternative, so they need to maximize the volume at their centers and achieve the best payer mix possible. Some of the things that can happen with mature ASC companies are partnerships with insurance companies to drive higher acuity cases to the low-cost ASC. They can also negotiate an increased professional fee for surgeons that take higher acuity cases to the low-cost setting. The insurance company would still save money on the case at the ASC and the patient would benefit from a lower copayment or health savings account payment. Those types of arrangements are likely occurring now with larger surgical center companies with the ability to negotiate with insurers at the regional or national level.

Q: What are ASCs doing today that won't lead to success in the future?

MR: The ability of ASCs to rely on out-of-network contracts will fall by the wayside, except for centers in underserved areas. If you are in an individual ASC that relies on out-of-network, you will have a significant challenge because it isn't always possible to negotiate increased professional fees.

ASCs have to pay close attention to insurance companies and work with them on carve-outs for high acuity cases. If you do a total knee at the surgical center, you may have tremendous reimbursement, but the overhead is high. The implant cost is high, along and you have to negotiate carve-outs so you can cover the cost of the case. We use enclosed surgical garments (space suits) during total joint cases to ensure a low infection rate. All this extra cost must be considered to keep revenue flow at the appropriate levels. With proper financial planning these high acuity cases can be a win for the patient, the surgical center and the surgeon.

More articles on surgery centers:
New Mexico joint venture to open orthopedic ASC – 3 insights
What the rise in high-deductible health plans mean for ASCs
Current concepts for ASC growth, success today

 

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