At the 11th Annual Orthopedic, Spine & Pain Management-Driven ASC Conference in Chicago on June 13, a roundtable of ambulatory surgery center industry experts discussed what works business-wise and clinically for orthopedics and spine in ASCs. The roundtable included Vice President of Acquisitions and Development at Ambulatory Surgical Centers of America Jeff Peo; CEO of National Medical Billing Services Nader Samii; Medical Director of Spine Team Texas David Rothbart, MD. The panel was moderated by Brad Gilbert, former professional tennis player and analyst for ESPN.
“All of us who have been in this business live with a five-year plan, and in the 20 years I’ve been in business I can’t remember my five-year plan changing so much from one year to the next,” said Dr. Rothbart. “Where we see the real opportunity is to position ourselves where we still have access to the patient population and get paid for the care we are providing.”
1. Seek opportunity in changing times
Survey your landscape and find where the opportunities are, even amid the constant change in the marketplace. “We are in a time of evolution in healthcare and I believe that this cataclysmic change is an opportunity,” said Dr. Rothbart. “Where there is chaos there is opportunity, and the strong will survive. One of the strategies we took was to sell a portion of our ASCs to the major healthcare systems to have access to contracts, and that changed our financial outlook significantly.”
2. Stay abreast of revenue cycle updates. The panelists discussed the revenue cycle and billing challenges as one of the big threats and opportunities for ASCs. “We live in a complex reimbursement environment,” said Mr. Samii. “We are constantly facing pressures on fees and reimbursement. Our business and all revenue cycle companies operate in a way where we charge a percentage of what the ASC collects. With inflation, expenses are only going to go up, so we have to find a way to operate in that scenario by cutting costs and being innovative.”
3. Evolve with technology
Technology, Mr. Samii said, is one-way healthcare businesses can work faster and use fewer resources. Another huge challenge will be the conversion to ICD-10 and new payment structures coming forward in the wake of healthcare reform.
“From our perspective, to win and survive in this industry long-term, we had to evolve from being just a billing and coding company to becoming more of a business adviser to clients,” said Mr. Samii. “There is a challenging landscape out there with new automation, ICD-10 and changes in payment structures coming in. Any changes in payment methodology require great expertise in contracting and ASCs are trying to figure out how to select the right electronic medical record to dive deeper into data.”
4. Move quickly to maximize revenue opportunities
Mr. Peo said ASCOA has focused on the top and bottom line growth for each individual center.
“We are looking at the profitability of individual specialties,” said Mr. Peo. “The things we focus on have a higher profit margin and deliver better top and bottom line numbers. A lot of the new procedures we can add right now are things we ignored in the past because they were difficult to implement. Now that the payer environment accepts orthopedics and spine, these are things we’re considering more and more today.”
ASCs must figure out how to evolve quickly and be flexible with their decisions. “The key to survival is to be nimble and take the opportunities to evolve and make decisions more quickly,” said Mr. Peo. “Consider a hospital joint venture, but that may or may not be the best thing. We have areas and locations where it makes sense and other areas where it doesn’t. Add new services or procedures within your core specialties and focus on educating payers to help them understand why these cases should be done in the outpatient instead of the inpatient setting.”
5. Find a way to work around hospital employment of surgeons
Hospital-employed physicians are another trend making a big impact on surgery centers and the success of outpatient orthopedic procedures.
“We are seeing more hospital employment, and there have been a few situations where the hospital is willing to joint venture with us,” said Mr. Peo. “If you have that in your market, take advantage of it. Orthopedics seems to be one area where there are a lot of mavericks that want to stick it to the hospitals. As you see the new lines of service or accept care pushed to the outpatient setting, you’ll see orthopedics and spine cases grow. We are seeing a lot of interest in doing total joints, but we have to find the right clinical situations and payers to take advantage of those procedures in ASCs.”
6. Spread the word about lower costs
ASCs generally have significantly lower costs than hospitals for the same procedure, but many patients and employers don’t realize the savings they could realize by insisting their cases be done in the outpatient setting.
“The end goal of healthcare reform is to drive down costs,” said Mr. Peo. “We know we are the low-cost provider for delivering care to patients. We’ve got to be loud and vocal and make sure patients and physicians know we are the place that can provide that.”
7. Take advantage of the industry springing up around outpatient orthopedics
More orthopedic and spine surgeons are training on minimally invasive spine surgery techniques during their fellowships, so their mindset is already headed toward less invasive procedures appropriate for the ASC setting.
“When I went through my training there was no such thing as minimally invasive, but we have seen a big change for smaller incisions,” said Dr. Rothbart. “The younger generation is exposed to these procedures, and generally we are seeing more orthopedic spine surgeons with the mindset to doing outpatient spine surgery in the ASC setting.”
Device manufacturers are also jumping on the outpatient orthopedic and spine surgery trend, some even developing whole lines for the ASC setting. “There are device companies focused on total joint programs for outpatient care delivery,” said Mr. Peo. “That’s where surgeons want procedures done and patient satisfaction in outpatient surgery centers is critical. I think you’ll see a huge explosion of cases coming to the outpatient setting as more data is collected on the care and recovery process.”
8. Schedule cases appropriately to maximize resources
Patient selection and appropriate scheduling are critical to the ASC’s success. Front office staff must form a relationship with the physician’s schedulers and understand how to maximize collections — either by preauthorizations or compact scheduling — for real success.
“You need a strong process in place on the front end to collect from patients and aggressively follow up with patients who don’t pay on the day of services,” said Mr. Samii. “Also have someone monitoring claims to make sure they are coded properly and follow up with them. If you can get these area processes tight, it will significantly help profitability.”
Mr. Peo recommends consolidating schedules to eliminate downtime between cases. “This takes an effort to get physician owners to agree to a compact schedule,” he said. “However, if you are able to cut them a larger check-in distributions, or tell them what their check would have been, it’s an eye-opening experience and fosters change within the physician group.”
Ref. Becker’s Healthcare
This post was first published July 2, 2013 and was updated July 29, 2020.