Changes in reimbursement have pushed the envelope regarding efficiency and fiscal responsibility significantly over the past five years. Surgeons find themselves working to do more cases to maintain the reimbursement volumes of the past. This has occurred while many hospitals work to streamline efficiency and OR throughput. Traditionally, ASCs run efficient ships, leading ASCs to push even more for cases.
In the future, more ASCs may find it fiscally beneficial to have selective OR closings on lower volume days. They may find benefits in alternative OR scheduling and moving away from designated "block" time or ORs. This has been done over the years in select settings, but the changes in reimbursement and the healthcare landscape may push ASCs to 
have standing policies in this regard.
Orthopedic surgeons must champion the collection of cost, efficiency and patient-reported outcomes data. In the past, the monitoring of cost and efficiency was done to ensure the solvency and financial success of ASCs. Managing overhead was done to ensure a healthy case throughput and profit margin. ASCs will be challenged as cost, efficiency and outcomes data for facilities will be requested from patients, third-party payers, alternative payment plan organizations partners and stakeholders. Some will request this data for presurgical approval for procedures.
Overtime, those ASCs who can produce the necessary quality and efficiency analytics will rise to the top and potentially become "preferred" or "designated" facilities for payers, patients and other healthcare industry partners. ASCs have long been shown to be most efficient in comparison to in-hospital surgical environments. The key will be in the collecting, reviewing, learning and pushing forward with effective and sustainable improvement based on that data. There is opportunity in the evolving healthcare landscape for those ASCs who are willing to meet t
he challenge.
The timeframe and swiftness of the implementation of the ACA has surprised many. CMS has pushed forward with alternative payment model initiatives much faster than many may have hoped or believed possible. Third-party payers have followed suit, and those who have not will do so quickly. Such wide-scaled change presents a challenge. Despite this, those organizations and ASCs that are willing to be innovative and move beyond the routine and embrace this current healthcare evolution may find themselves leading the pack in the future.
Dr. Freddie Fu is pictured on the left and Dr. MaCalus Hogan is pictured on the right.