The most dangerous orthopedic ASC trends

From rising costs to payer delays, three physicians told Becker's what they view as the most dangerous trends for orthopedic and spine ASCs in 2024. 

Reuben Gobezie, MD. Director of the Cleveland Shoulder Institute and Regen Orthopedics and CEO of Genie Health (Mayfield Heights, Ohio): The most dangerous trend as pertains to spine and orthopedics in the ASC presently are:

1. The increasing costs of implant pricing whilst a decrease in reimbursement is consistently being realized. Innovation will suffer in the U.S. healthcare system and facilities are not allowed, due to archaic Medicare rules, to balance bill patients for the costs of new/cutting-edge implants. This fact reduces the patients' ability to exercise choice in what implants [what quality] are used in their surgeries. The insurance companies and Medicare rules force ASCs to decide between quality of implants and business viability.

2. The delays in payments by insurance companies, along with a dramatic increase in denials for surgical services and the increasingly arduous processes for prior authorization of procedures. The reality is that many insurance companies are delaying payments for services rendered and are denying portions of the services using "arbitrary law." The appeals process is costly to the ASCs and, in effect, results in an ever-increasing amount of "free care" in the system. We need to allow balance billing for implants so that patients have the ability to purchase more innovative implants without asking the ASC to pay for it whilst the insurance companies pay less. The fact is that insurance premiums and patient responsibility continue to rise and increase, respectively, and the payments from insurers to private practices continues to decrease.

Samer Hasan, MD, PhD. Department Chair of Orthopedic Surgery at the Jewish Hospital (Cincinnati): The most dangerous U.S. trend in spine and orthopedics is the never-ending cycle of declining reimbursement to both hospitals and surgeons, often seemingly in direct response to improved efficiencies and productivity. Reimbursements to surgeons for joint replacement surgery and to ASCs for outpatient total joint replacement are two glaring examples, but there are many others. One recent study presented at this year's American Academy of Orthopaedic Surgeons annual meeting projects that surgeons will get reimbursed less than minimum wage for primary total joint replacement by 2030. This downward spiral impedes the adoption of new technologies that might otherwise improve and optimize patient care, pressures surgeons to change their practices or exit the specialty altogether, and stifles the recruitment of new orthopedic surgeons. In the end, none of this helps our patients.

Shane Nho, MD. Co-Director of the Division of Sports Medicine at Midwest Orthopaedics at Rush (Chicago): With cases moving to the outpatient setting, the surgical team needs to coordinate any medical concerns with the anesthesia team to ensure that the right patients are having surgery in the ASC environment. Hospitals will still need to be necessary for surgeons who have patients with medical comorbidities.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast