The trends ASCs should know in outpatient orthopedics & other thoughts from Dr. Louis Levitt

Louis Levitt, MD, vice president and secretary of the Centers for Advanced Orthopaedics in Bethesda, Md., spoke to Becker's ASC Review about his thoughts on the recent proposal from CMS, trends in outpatient orthopedics and more.

Note: Responses have been lightly edited for style and clarity.

Question: What’s your reaction to CMS’ proposed decision to pay for total knee replacements in ASCs?

Dr. Louis Levitt: We have learned that performing surgery in the outpatient setting is an exceptional model of care for the right patient. Patients can mobilize faster, return to the workforce sooner and they are regularly quite pleased with the outcomes. We should be incentivizing surgeons to perform these surgeries outside of the hospital when appropriate so the patient can enjoy a decreased risk of infection, more convenient care and a quicker return home.

Currently, the CMS proposal does not reflect a realistic reimbursement figure that would cover the cost of the implant as well as clinical costs, so it is not financially feasible to move the total knee replacement from the hospital to the ASC at this time. However, there still seem to be some unknowns related to this decision, and we as physicians look forward to moving total knee replacements into the ASC setting so that we can care for Medicare recipients more efficiently when it’s not essential they receive treatment in the hospital.

Q: What do you think the ASC industry will be like in three to five years?

LL: There will continue to be strong growth, driven by high patient satisfaction rates and better outcomes compared to the hospital setting. In 2017, ASC volumes increased by 22.9 percent nationally, and the market is forecast to surpass $40 billion by 2020, according to the Advisory Board.

The initial push for ASCs was driven by common, simple musculoskeletal processes, and the orthopaedic community served as the impetus for ASC profitability. With better anesthetics and pain control, better management of blood and blood products and a healthier patient population, we can now offer outpatient services that were traditionally primarily done in the hospital setting. What’s more, there are very few elective surgical procedures that require patients to stay in the hospital for longer than one day, so expanding ASCs to offer 23-hour stays will further increase the volume and type of outpatient procedures.

In the future, I believe ASCs will expand beyond just orthopedics, and patients will also have access to more sophisticated procedures in the outpatient setting. I expect we will begin to see outpatient cardiology procedures such as cardiac stents and limited procedures on the heart valves, which can be done effectively and safely on the right patients who qualify for outpatient surgery. We’ll also see continued increase in outpatient spine surgery.

Q: What current trends are you seeing in outpatient orthopedics?

LL: I believe that ASCs are going to follow the trend toward consolidation that much of the healthcare industry has already seen. I anticipate that a small number of corporate entities will begin a rapid acquisition of surgical centers, followed by consolidation and specialty concentration. In the future, surgical centers may operate similarly to acute care hospitals, with centers that specialize in joint replacement, or urology, or OB-GYN cases. Consolidation and specialization will allow for more efficient use of anesthesia, supplies and resources, more effective negotiations with payers and economies of scale that will benefit both the patient and the surgeon.

Patients will come to expect even higher-quality, more efficient and cost-effective care in outpatient facilities that are comfortable, specialized and delivering strong outcomes. They’ll also have access – at their fingertips – to greater levels of transparency for pricing between hospitals and ASCs. Last November, CMS launched a new online tool – Procedure Price Lookup – that lets patients search a procedure and see instantly how much more affordable care is in the outpatient setting. This trend will only continue.

Consolidation will benefit patients, particularly those who may prefer to receive care in an ASC when possible, where the administrative process is simpler, there is less paperwork, and we have better continuity of care.

Note: Comments on CMS' proposed changes to the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs can be submitted here. Comments will be accepted no later than 5 p.m. EST on Sept. 27.

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