At the Becker's ASC Review ASC 23rd Annual Meeting: The Business and Operations of ASCs on Oct. 28 in Chicago, three leaders from "the big three" outpatient specialties — orthopedics, ophthalmology and gastroenterology — gathered to talk about their specialty's future in the outpatient market.
The panel featured John Bello, MD, an ophthalmologist; Arvind Movva, MD, CEO of Heartland Clinic & Regional SurgiCenter in Moline, Ill., and founder and CEO of divvyDose; and Adam Berry, CEO of Summit Orthopedics in St. Paul, Minn. Sandra Jones, executive vice president and COO of ASD Management, moderated the panel.
The following are three key points on the future of these three specialties, pulled from the panel discussion.
1. Procedures are moving from the ASC or hospital into a physician office with varying degrees of success. For instance, in ophthalmology, most procedures are done in an ASC, with little movement toward in-office procedures, Dr. Bello explained. While CMS is considering reimbursing for cataracts done in-office, Dr. Bello is "concerned with the liability issue" there.
In orthopedics, Mr. Berry's practice moved pain injections from the ASC to the physician office roughly six years ago, he said, to get ahead of the market and offer a lower-cost point of care. But after five years, he found the pain injections were "such a low-level item for health plans" that payers didn't have any "desire or interest to do it in that space." So his practice moved it back into the ASC environment.
Similarly, he said he sees the potential for some cases, like carpel tunnel release, to be done in the office, but "we don't see payers making any push or desire for it yet, so we haven't wanted to pursue it very aggressively."
Dr. Movva said many GI procedures have been done in-office in the past. The opportunity to move procedures in-office has grown with the advent of bundled payments, since the procedure can be done at a lower cost at the same level of quality.
2. Bundled payments are growing in popularity. In general, bundled payments are picking up steam in the industry, but providers in these three specialties will need to work with payers to get a bundle that is good for both parties. Right now, "if it requires taking slightly less in a bundle but can get more volume and better relationships for the future, I think it's totally worth it," Dr. Movva said.
Mr. Berry's group has started bundling already, but the whole process took 14 months from the beginning to signing the contract. "The difficult part is getting the payers to see it's a win for them," he said, because often medical directors at health plans are reticent to move procedures to outpatient settings. To overcome that, physicians need to educate them on the safety and efficacy of performing certain procedures in an outpatient setting.
3. Standardizing supplies leads to cost savings. When it comes to bundling payments, many ASCs find cost savings in standardizing physicians' preference cards and only supplying two or three types of implants or other tools. For instance, Mr. Berry's outpatient center is limited to two implant vendors. He said alignment with physicians was key to the success of this effort — they brought physicians to the table from the outset and achieved a 95 percent acceptance of adhering to the total joint pathway established at the center.
In ophthalmology, Dr. Bello had a different experience with standardizing lenses and other products in his center. For success here, he said choosing the right physician investor is critical. "With physician investors, you need to get people with the right mentality, who understand they need to compromise and the center is their main objective and not necessarily themselves," he said.