Anthony Bevilacqua, MD, a surgeon at Suffolk, Va.-based Sports Medicine & Orthopaedic Center, joined Becker's to discuss payer trends and how ASCs will be affected by a potential economic downturn.
Editor's note: This response was edited lightly for brevity and clarity.
Question: What payer trend is concerning you the most right now?
Dr. Anthony Bevilacqua: In terms of the payer trend most affecting the surgery centers, I believe it's an ongoing and evolving problem of payers not covering needed implants. Surgeons will sometimes try to fix something by other means if implants are not available or covered by insurance. Since more complex problems are progressively shifting to outpatient areas; this problem is likely to worsen. It might be an appropriate time for a consideration of how to convey a portion of implant costs to the patient in terms of deductible as an alternative to denying them altogether.
Q: How will a potential economic downturn affect ASCs?
AB: The economic downturn will have an impact on surgery centers or outpatient growth as it pertains to elective procedures. Insurance copays are often not possible within a budget and historically, economic hardships for the nation typically result in less elective surgery In the case of orthopedics, however, the failure to get fixed often results in reduced activity or diminished lifestyle until the procedure can be done. Patients will often work as a result of their pain, and that has further impact on the economy. The only solution would be for insurance companies to reduce out-of-pocket expenses for their beneficiaries in times of economic hardship.