Payers, hospitals turning to the ambulatory space for orthopedics

The migration of orthopedic procedures from the inpatient to the outpatient setting is not a new phenomenon, but it has seen significant growth in recent years with the advancement of clinical techniques and technology as well as the push to lower healthcare costs.

In a session at the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference, June 14 to 16, in Chicago, I. Naya Keyayes and Todd Godfrey, both principals at ECG Management Consultants, discussed key considerations for orthopedics in the ambulatory setting.

Ms. Keyayes noted the movement of orthopedic surgery from the inpatient to the ambulatory setting provides a big opportunity for ASCs. In the current environment, ASCs can present significant savings for payers, especially for high-acuity cases, such as orthopedic procedures.

"Payers are very interested," she said. "But it depends on market competition, from hospitals, other ASCs [and so on]. If you are in a market with lots of competition, payers will be very interested."

Increasingly, commercial payers are redirecting outpatient surgery to ASCs. CMS is expected to approve total knee replacements and total hip replacements for ASCs in the near future. Thus, hospitals will begin rethinking their alignment strategies. They will focus on how to align with orthopedic surgeons in the ambulatory setting, as orthopedics is a big book of business for hospitals.

Mr. Godfrey added hospitals are seeing the benefit of an ambulatory strategy. "It's important for hospitals to have strategic rationale to have proactive strategy instead of a reactive strategy," he said.

ASCs are also incentivized to find partners among private equity firms, venture capital firms and hospitals. There are several reasons for this, including the fact many older ASC facilities need to be updated or expanded, especially to capture newer orthopedic procedures.

Mr. Godfrey noted ECG Management Consultants was seeing three different types of orthopedic-focused services and models involving ASCs and capital partners:

• ASC only
• Ambulatory musculoskeletal care center, which includes physician office space and ancillary services
• Comprehensive musculoskeletal institute, which includes inpatient beds, a skilled nursing facility and extended care options

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