According to Dr. Bray, the biggest opportunity for orthopedics and spine is the ability to do higher acuity cases in the outpatient setting. "What we've seen is an ever increasing acuitity of cases," he said.
Dr. Prada agreed and noted, though, that there is a great degree of planning involved in bringing traditional hospital spine cases to the outpatient setting. "There is a lot of planning involved," he said, explaining that surgeons, anesthesiologists and staff must work closely together to ensure higher acuity cases will have accurate pain control and mobility.
These higher acuity cases are of interest to many centers because they demand higher reimbursement. Ms. Kehayes noted that private payors are more likely than in the past to approve spine procedures for the outpatient setting, but challenges remain. "The payors are coming around significantly," she said, but added that review with a payor's medical director is sometimes required.
Dr. Bray said he believes payors are a bit behind. In many cases, the cases he performs in an outpatient setting are new to the setting, and payors can be slow to approve the setting as an appropriate one. When he opened the center, it was 100 percent out-of-network. Now, his center's cases are 50 percent in network, a signal that payors are beginning to come around to paying for at least some outpatient spine procedures.
Mr. Zasa said he has found California payors are more accepting of these procedures. As a result, ASC Management encourages its California surgeons with experience working with payors to share their knowledge with surgeons at centers in other states.
While outpatient procedures may seem a benefit to payors because they cost less, Ms. Keyahes cautions that payors always consider their relationships with local hospitals before entering into a new contract. If a market has only one major hospital, contracting with a competitor to that hospital could put the payor's relationship with that critical provider at risk.
Toward the end of the panel discussion, the conversation turned shared savings agreements and provider risk arrangement. Dr. Bray said it is a concern for his center, and he is working to gather quality and cost data that could eventually be used to develop bundled packages to payors and hospitals. "In the future it's not going to be an independent hospital, payor our outpatient center," he said. Instead, the system will work together to ensure each patient receives care at the most appropriate type of facility.