In the next several years, ASCs will see steady demand for gastroenterology and ophthalmology procedures — but demand for orthopedic services will skyrocket, according to several panelists who spoke at Becker's ASC 26th Annual Meeting: The Business and Operations of ASCs on Oct. 25.
During a panel on how those specialties will fare in the next few years, moderated by Becker's Healthcare Editor-in-Chief Molly Gamble, the following participants discussed why they're optimistic about increasing ASC procedure volumes in the spaces:
- James Slover, MD, professor of the adult reconstructive division in the department of orthopedic surgery at New York City-based NYU Langone Orthopedic Hospital
- Bill Stewart, principal at VBC Consulting
- Steve Dunn, senior segment manager of ASCs and orthopedics for McKesson Medical-Surgical
- Rebecca Paine, vice president, administrator and CFO of Beckley (W.Va.) Surgery Center
The first growth-driver to note is that the U.S. population is getting older and heavier, according to Mr. Stewart. This population change creates tremendous opportunity in orthopedics, he said, which is a specialty that commercial and government insurers alike are pushing to the outpatient setting.
While traditionally done as inpatients, these types of surgeries are being encouraged to move to outpatient settings that provide "a much-needed service at half the cost in half the time and save the healthcare system a ton of money," Mr. Dunn said. "The demand is there and will continue to be there in spades."
For instance, UnitedHealthcare expanded prior authorization requirements and site-of-service medical necessity reviews for certain surgeries that could be performed in outpatient settings, and CMS proposed adding total knee replacements to the ASC-payable list in 2021, the panelists noted.
https://www.beckershospitalreview.com/finance/unitedhealthcare-s-policy-will-limit-outpatient-surgery-payments-to-hospitals.html
ASCs have the advantage of lowering costs, but they're also increasingly utilized sites of care because they appeal to all stakeholders, Mr. Stewart said.
"Surgeons love operating in ASCs. Obviously, there's a financial component [to that], but I think a lot of it is the ability to practice medicine like they want to practice medicine," he said. "Patients like it. Employers like it because it's less expensive. Now, we have to make sure payers are fully supportive [of the industry] and that hospitals are fully bought into it."
When it comes to accommodating growing demand, one of the biggest obstacles for ASCs will be finding physicians who fit into their culture, according to Mr. Dunn. Another big challenge is doing the right thing for patients, Mr. Slover added.
"When you're talking about something like joint replacement or spine surgeries transitioning into an outpatient or ASC center, it's [about] making sure you identify who can do that safely and what resources they need to do that safely," he said. "We need to work hard to define that. Safety comes first."
For Ms. Paine, whose center offers ophthalmology and GI services, recruitment will be the top priority looking into 2020; the center recently lost its GI physician to hospital employment. But like Mr. Slover, Ms. Paine remains focused on ensuring proper patient selection.
"While there are issues with patient selection because we're dealing with an elderly population, they're also receiving very limited anesthesia for [the ophthalmology procedures we offer], and that lends itself very well to continue to grow the volume in ASCs," she said. "We continue to grow that ophthalmology volume year over year, and I feel very positive that's going to grow."