The intertwined futures of ASCs and total joint replacement

Total joint replacements are high on the list of procedures that ASCs are eyeing for growth opportunities. 

"The biggest opportunity for growth in the next five years is total joints, more invasive spine surgery and robotics," Tina Driggers, an administrator at Winter Haven, Fla.-based Day Surgery Center told Becker's

Advances in technology have increased ASCs' ability to perform these procedures, as they are increasingly approved for outpatient settings. The use of robots in total knee arthroplasty increased sixfold between 2017 and 2023, according to the American Joint Replacement Registry’s 2023 report.  

While the high upfront cost of implementing robotics may give some ASC leaders pause, many have achieved significant returns on investment — especially when it comes to TJR. 

AdventHealth Surgery Center Blue Springs in Orange City, Fla., has seen seamless integration and significant success since acquiring the DePuy Velys robot for robotic-assisted total knee replacements, administrator Amanda Henshaw told Becker's

One physician at the center advocated strongly for the robot and its potential to greatly expand the center's TJR procedures. After a year of deliberation, the group's president negotiated an agreement with DePuy. 

The surgery center, a joint venture between Altamonte Springs, Fla.-based AdventHealth and physicians, has since achieved a 35% increase in total joint cases.

"It was a really seamless process," she told Becker's. "Once we got our robot, DePuy continued to be very supportive. They have three or four representatives present every time we use the robot, ensuring our staff is fully trained and prepared. Overall, the smooth integration is a credit to our president’s leadership and DePuy’s excellent support."

This is in part due to the specific arrangement achieved between DePuy and AdventHealth.

"For every DePuy joint procedure we perform, it counts toward a case volume agreement," Ms. Henshaw explained. "Essentially, we don’t pay out of pocket for the robot — it’s covered by meeting the agreed case numbers. We’ve consistently exceeded the required volume each month because the process has been so smooth and the doctors love using the robot."

While robotics are promising, there are still numerous challenges ASCs face in expanding their TJR procedures. 

Staffing is still a struggle across healthcare, and successful outpatient TJR procedures rely on well-trained physicians with experience in surgery center management. Steven Barnett, MD, CMO of the Hoag Orthopedic Institute of Irvine, Calif., told Becker's, “You need very competent management and leadership from the board of directors and staff to make it work.”

Reimbursements are another challenge. Despite the technological advancements that have made ASCs a viable setting for TJR, reimbursement for these procedures still remains lower than those in the hospital setting. In 2022, ASCs accounted for 8.6% of the total TJRs with the lowest reimbursement per procedure, according to a November 2024 study in The Journal of Arthroplasty

Despite this, Ms. Henshaw maintains a positive outlook on ASCs and TJR moving forward. 

"ASCs are the future," she said. "With Medicare approval, we’re now able to do more, including robots and total joint procedures in an outpatient setting. I think it’s an excellent investment for other ASCs to consider for their surgery centers."

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