ASCs have been looking to high-acuity orthopedic procedures for years as a growth strategy, and this trend will only pick up as CMS continues to approve these surgeries for the ASC setting.
Here are three procedures that ASC leaders are currently eyeing for growth:
Total shoulder arthroscopy
In its 2024 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule released Nov. 2, CMS added 11 procedures to the ASC-covered list that were not included in the proposed rule, including total shoulder arthroscopy.
Many leaders are now scrambling to add total shoulder service lines to spur orthopedic growth.
"With CMS' sudden unexpected release of total shoulder arthroscopy to the ASC covered procedures list, I find myself scrambling to meet with our surgeons and staff to begin planning for the first of the year," Alfonso del Granado, administrator and CEO of Lubbock, Texas-based Covenant High Plains Surgery Centers, told Becker's.
"My top priority is getting total shoulders started now that CMS has approved coverage," Fawn Esser-Lipp, executive director at the Franklin, Wis.-based Surgery Center, told Becker's. "I will need to work on getting instrumentation, procuring equipment and staff training."
Total knee arthroscopies
The number of knee replacement procedures occurring outpatient has increased 293% in the last four years, according to a "Strata and Syntellis Performance Trends" report.
Total knee arthroscopy procedures, which were added to the ASC-payable list in 2020, are also one of the most expensive procedures performed in the outpatient setting, so ASC leaders have a lot to gain by offering them.
"As we have plans to kick off our total joint program in the beginning of 2024 with total knee arthroplasties, I would like to see that service line grow into shoulders and hips as the year goes on," Erin Vitale, RN, director of nursing at Hoffman Estates (Ill.) Surgery Center, told Becker's.
Additionally, margins for outpatient knee replacements are much better than margins for those performed in the inpatient setting.
Transforaminal lumbar interbody fusions
"My top priority for 2024 is to transition 'higher acuity' spine procedures like transforaminal lumbar interbody fusions back to the ASC," Kenneth Nwosu, MD, spine surgeon at Puyallup, Wash.-based Neospine, told Becker's.
These procedures were routinely performed in ASCs during the COVID-19 pandemic and the provisions of CMS' Hospital Without Walls program, Dr. Nwosu said. But after the program ended, it became more cost-restrictive to perform these procedures at ASCs.
Rather than waiting for CMS to update their policies, Dr. Nwosu and his team plan to "demonstrate the discrepancy empirically in our experience," in hopes that they will be "granted a carve out" to perform these procedures in the ASC setting again.