Three orthopedic surgeons connected with Becker's to discuss the biggest barriers to orthopedic ASC growth.
Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.
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Editor's note: Responses have been lightly edited for length and clarity.
Steven Barnett, MD. Chief Medical Officer of the Hoag Orthopedic Institute (Irvine, Calif.): It's easy to get on the optimist bandwagon for the future growth of orthopedic ambulatory surgery centers. All signs, from demographics and disease prevalence to new reimbursement and greater migration of more orthopedic procedures to the ASC setting, make this very attractive for individual orthopedic surgeons as well as inpatient hospitals.
That said, challenges remain. This is not a no-brainer business. You need very competent management and leadership from the board of directors and staff to make it work. ASC procedure reimbursement is typically lower than that seen in an inpatient setting. This is especially true for historical inpatient procedures like total joint arthroplasty and spinal decompressions which are migrating to the ASC setting. These procedures also require more equipment and space which impacts capital expenditures required from participating surgeons.
It is imperative that leadership partner with like-minded surgeons and anesthesiologists who are 100 percent behind support for the center and share similar culture and values in patient care. Physician alignment is critical. Efforts need to strive for maximizing efficiencies with respect to room utilization and turnover as well as appropriate staffing. Leadership and physician partners should always be on the same page when it comes to putting the patients first in these episodes of care. As always, the right surgery at the right time in the right setting should be the mantra to live by.
It takes experience in orthopedics and in surgery center management to perform. Growth should be analyzed and measured with experienced people with a track record of success. There are simply too many competitors and challenges to assume that success is imminent, and there is more competition from large and well-funded institutions to come.
Emeka Nwodim, MD. Orthopedic Surgeon at the Centers for Advanced Orthopaedics (Bethesda, Md.): I believe that heavy lobbying from hospital and healthcare entities presents the biggest barrier to orthopedic ASC growth. Restrictions on insurance authorizations and reimbursements are also a challenge.
Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Tacoma, Wash.): Despite the booming growth of orthopedic care being provided in ASCs, there are certainly several challenges that we will face as we grow this area of care with ongoing demonstration of safety and value within those walls.
The two biggest barriers are related, and that is the people and the costs of the activities/services that those people are providing.
Staffing is clearly an ongoing struggle throughout the entire healthcare landscape. Nurses and other important front-line staff left the profession during the pandemic, and centers that laid off staff during the past year are finding it difficult to fill those open positions. This challenge is amplified by ASCs proposing to remain open later into the evenings and on weekends to provide greater access to patients. Attracting talent and building a team to keep our strongest personnel will be crucial in the upcoming year.
Costs are rising. Not just for medications and basic equipment, but also for specific activities/services, enabling technologies and growth itself. Especially in our current landscape where data transparency is coming to the forefront, there will be costs associated with building and maintaining large data infrastructures that mirror our larger hospital partners. Gathering and reporting data is not cheap but certainly necessary to determine the value of various purchases, driving patient safety and hiring new team members.