Four leaders joined Becker's to discuss the biggest growth opportunities for ASCs.
Editor's note: These responses were edited lightly for clarity and length.
Sean Hartzell. Principal of ECG Management Consultants:
- Growth opportunities continue to percolate around the low- to medium-acuity outpatient and single-night stay inpatient cases performed in the hospital setting.
- Continued growth in the gastrointestinal and colorectal area with the increased screening guidelines.
- There is growing demand to incorporate lower-acuity cardiology procedures, although that growth is taking time.
- There is continued expansion of robotic cases into ASCs, although reimbursement rates temper that growth in the short term.
Michael McClain. Founder of LeftCoast Healthcare Advisors: To me the three primary areas for growth are as follows:
1. Cardiovascular/vascular services: Both interventional cardiology and electrophysiological
2. Robotically assisted orthopedic and spine procedures will continue to accelerate into the ASC space, especially as robotic services become more affordable through creative financing models and payers again comfort understanding of the value ASCs can bring to patients and communities in this space
3. I also think one incredibly underserved area of support that is poised for growth is women's services (gynecology, urology and breast care). This area has historically been underserved in the ASC space, partly because of the cost of the equipment and the focus on higher margin business, but I personally feel there is tremendous potential in supporting programs that offer same day alternatives for cancer care, biopsies, hysterectomies, etc. Traditionally reserved for cancer centers and hospital outpatient departments, this is clearly an area where ASCs can excel, and partner in communities to provide unrivaled access and care.
Alok Sharan, MD. Surgeon at Spine and Performance Institute (Edison, N.J.): Many spine surgeries are successfully being performed in the ASC environment. Laminectomies and anterior cervical discectomy and fusion have been shown to be safe in this environment. There has not been much migration of lumbar fusions to the ASC environment. This is the growth opportunity for ASCs.
At our practice, the Spine and Performance Institute, we have created a rapid recovery spine surgery protocol that allows patients to go home the same day after a lumbar fusion. We have integrated our awake spine surgery techniques, regional anesthesia, along with nutrition optimization. ASCs could benefit from partnering with physicians who can successfully optimize their patients prior to surgery - to be able to successfully complete an outpatient spinal fusion.
Jon Vick. President of ASC Consulting Company Vick & Company: Many ASC owners and administrators are finding that their ASC capacity is already being stretched to the limit and scheduling is becoming more difficult. Turning business away or scheduling into the future is not good for business or for the reputation of the ASC. Many ASCs need more operating rooms to handle current and projected business. Some centers need larger operating rooms to allow for added specialties and the new procedures being performed at their centers. Others may need a major renovation or additional locations. According to VMG Health, the average gross cost of adding an OR to an existing ASC, including plant, infrastructure, tenant improvements and equipment is $1.4 million, so to add 2 ORs and a procedure room could cost $3 million or more.
There is an alternative to paying cash or taking out a loan to pay for the expansion or renovation of your ASC: a sale-leaseback of the ASC real estate to a buyer who will fund the expansion and/or renovation. These real estate buyers can also fund the construction and development of additional facilities. One of the best ways to maximize growth for your ASC and attract more cases is to create optimal OR availability for the surgeons. It is best to plan an expansion long before you reach capacity and to minimize cost to the partners through a sale-leaseback transaction that provides the capital for the expansion.