Here are six steps to take when considering and establishing the orthopedic specialty in your ASC.
1. Ensure that the ASC is equipped with the proper budget to handle the new specialty. To start, an ASC must assess whether the orthopedic specialty would be an appropriate avenue to consider for the facility — beginning with the center's budget. "If you're adding orthopedics, you should plan on adding about $200,000 in equipment and perhaps another $100,000 if you're going to add the spine specialty of orthopedics," says Mr. Martin. "It's a significant capital expenditure."
Centers should budget for new video equipment, instrumentation sets, fluid management, an orthopedic table and video towers. Spine cases would require the same supplies, often with the addition of a microscope and spine table, says Mr. Martin. Centers should discuss the specific type of equipment, sets or towers that the orthopedic surgeon would require for cases. "These are pretty significant expenditures, but on the other hand, reimbursement on these cases is often very good," he says.
2. Identify employees with orthopedics experience. ASCs should examine the current clinical employees to determine if they have orthopedic or spine experience from previous ASCs or hospitals, Mr. Martin says. If not, additional employee training will be required.
3. Locate orthopedic physician candidates. An ASC should turn first to its existing physicians, who will likely know the best orthopedic surgeons in the community and also their availability and relationships with existing hospital systems. "We then have candidates tour the facility, meet our clinical managers, and a few physicians, and if there is a good fit start the credentialing process," says Mr. Martin. From there, potential surgeons should be given a trial period to determine if they fit in well at the center.
"What we like to do is have a physician utilize the facility for about six months before offering an ownership opportunity," says Mr. Martin. "It gives the physician time to see if there's a good fit at the facility, if they are comfortable with staff, the anesthesia and the equipment. It also gives the ASC the opportunity to see if this physician gets along well with employees and physicians, follows facility policies, is efficient and utilizes supplies and equipment well, and also if the physician will add to the facility’s reputation for high quality and excellent outcomes."
4. Evaluate managed care contracts to determine if you have implant reimbursement. Because many orthopedics procedures require implants, good reimbursement contracts are very important, says Mr. Martin. If a center does not have them, it will take time to renegotiate with the facility’s major payors. "Often the best time to add implant reimbursement to a contract is when a new term is being negotiated," says Mr. Martin. It doesn't hurt to start the implant discussion at any point, even if the center is only considering adding the orthopedic specialty. "For the insurance company, if these cases are done in an outpatient setting, it amounts to significant cost savings," says Mr. Martin. "Many ASCs have excellent quality in terms of outcomes, low transfer rates and low infection rates, and patient satisfaction — these can be identified for an insurance company in order to add implant reimbursement."
5. Identify subspecialty within orthopedics. Sports medicine, hand, shoulders and elbows are all excellent outpatient subspecialties for orthopedics, says Mr. Martin, while orthopedic surgeons focusing on total joint replacement are often more comfortable in a hospital setting. "Sports medicine is very good because knee arthroscopy is one of the main procedures done, and the shoulder, elbow and hand specialties would all bring good opportunities as well," he says.
6. Discuss caseload and supplies with potential surgeons to asses the inflow of revenue. "You want to understand what sort of outpatient cases the surgeon does — a busy orthopedic surgeon can do more than 30 cases per month," says Mr. Martin. "You also want to identify if you have insurance contracts with the companies that the orthopedic surgeon has in his current patient mix."
When all of the above factors are taken into account, adding orthopedics to a facility’s specialty mix is often an excellent fit, he says.
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