While some orthopedic and spine experts are optimistic about the future of independent ASCs, others are not so sure. While more orthopedic procedures are migrating to the ASC setting, independent ASCs still face unique regulatory and economic barriers.
The executives featured in this article are all speaking at Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference at the Swissotel Chicago.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at the conference on June 15-17. The following are answers from our speakers.
To learn more about this event, click here.
If you would like to join as a speaker, contact Claire Wallace at cwallace@beckershealthcare.com.
Question: Is your outlook for independent ASCs bright or dark? Why?
Akshat Gargya, MD. Assistant Professor of Anesthesiology and Pain Management at the University of Vermont Medical Center (Burlington): The outlook for independent ASCs is generally favorable and promising. ASCs are known for providing surgical care at a lower cost compared to hospitals, have shorter patient stays and lower overhead costs, making them a cost-effective option for many surgical procedures. ASCs often have specialized focus areas, such as orthopedics, ophthalmology or gastroenterology, allowing them to develop expertise in specific procedures. This specialization potentially leads to increased efficiency and better outcomes, although more research is needed to evaluate outcomes. As the population continues to age and the prevalence of chronic conditions increases, the demand for surgical procedures is expected to rise. ASCs are well-positioned to meet this demand due to their ability to provide efficient and timely surgical care. Reimbursement rates for ASCs have been improving over the years, making it financially viable for physicians to establish and operate independent ASCs. Medicare and private insurers have recognized the cost savings associated with ASCs and have adjusted their reimbursement policies accordingly. However, it's important to note that the success of an independent ASC depends on several factors, including the local market dynamics, competition, regulatory environment and financial management. It's crucial for ASCs to stay updated with industry trends, maintain high-quality standards and adapt to changes in the healthcare landscape to ensure long-term success.
Albert Wong, MD. Neurosurgeon at Docs Health (Los Angeles): The future for outpatient surgery centers will be a booming industry. Technology continues to improve and trend toward minimally invasive surgeries with smaller incisions, less blood loss, lower postoperative narcotic requirements and shorter length of stay. Similarly, technological advances to robotic navigation, endoscopic surgeries and artificial intelligence continue to simplify complex surgeries that will increase the overall volume of outpatient surgeries.
Alejandro Fernandez. CEO at Synergy Orthopedic Specialists (San Diego, Calif.): The future is bright due to consumer demand, cost-effectiveness and the ability to offer greater ownership and governance to physician owners. However, there are challenges, such as recruiting physicians, dealing with insurance reimbursement and staying competitive in the market. Some independent ASCs have sought partnerships with national players and hospitals to address some of these issues, while others continue to focus on offering high-quality care, adapting to changing trends and technologies and providing exceptional customer service to set themselves apart. Ultimately, the future of independent ASCs may depend on various factors, including location, specialty, patient demographics and healthcare policies.
Alfonso del Granado. Administrator and CEO at Covenant High Plains Surgery Center (Lubbock, Texas): My outlook on independent ASCs is mixed. I think large, multi-specialty ASCs will have trouble remaining fully independent as more practitioners move to group and hospital-owned settings. The ones that will have the easiest time are those with active, high-performing partners and have strong mechanisms in place to shed dead weight and remain attractive to new incoming partners, while those that are top-heavy will flounder.
Smaller, especially single- or limited-specialty independent ASCs, will also thrive so long as they are attached to active and growing surgeon groups, but their lack of risk diversification will make them more vulnerable to referral practice patterns, contract issues and labor and medical supply cost concerns.
I am more optimistic on joint ventures that include a hospital or health system with enlightened, hands-off leadership, a streamlined management company and active physician partners. I think this combination helps to address concerns regarding efficiencies of scale for purchasing and payer contracting, aligned producer incentives and an educated, professional leadership.
Amit Patel, MD. CEO and Pain Specialist at Summit Spine & Joint Centers (Lawrenceville, Ga.): The ASC outlook is bright! I run 14 pain ASCs in the southeast and I believe the movement of outpatient procedures from the hospital to the ASC setting will continue. Payers appreciate higher quality, lower cost services for their patients.
Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: Overall, the outlook is mixed for independent ASCs. This is an era that is very different from, say, 10 years ago. We know private equity is building large portfolios of both physician practices and some ASCs. Surely they can make money; it is kind of their whole thing. Staying independent is harder for two simple reasons: The diminishment of physician reimbursement may make them less likely to want to invest in independent ASCs, and the second is the incredible financial pressure of rising cost of doing business.
There are some centers that are going back out of network that I very much support. I believe fee-for-service procedures are not dead, despite the hoopla. Most of the folks ballyhooing about contracts have worked hard to negotiate the payer contracts and hopefully good carve outs, but again, will the payers pay? It is all too easy, as we have all seen, that payers randomly change the language in their contracts, begin bundling codes and then not paying line items properly in an effort to squirrel away their money. The recourse being litigation, which is costly. That is why I believe doing cash price procedures, either direct to patients and having them do HSAs, FSAs, or payment plans to get the good care they want or having their employers foot the bill for a reasonable all-in price.
Bruce Feldman. Associate Administrator at SUNY Downstate Medical Center (New York City): I feel the outlook for independent ASCs is dark as we see more and more independent ASCs be acquired by large healthcare systems, ASC management companies and private equity firms. This is being driven by, for the most part, an effort to obtain higher reimbursement rates from commercial payers. As the adage goes, there is "power in numbers." I think this trend will continue, especially as we see more and more private physician practices being acquired by hospitals.
Bus Tarbox, MD. President of Columbia (Mo.) Orthopaedic Group: This is an interesting question. The independent ASC outlook is guarded. I do believe that the migration of site-of-service to the ASC has been a great benefit to our patients. We know that the cost of service is lower, the complication rates are lower and the patient satisfaction is higher when procedures are done in an ASC. This makes the outlook bright as we continue to find ways to move higher acuity procedures to the outpatient setting.
However, there are many obstacles lurking in the way that cause concern. The major issue revolves around the workforce issues in the post-pandemic world. The anesthesia workforce is a large obstacle as certified registered nurse anesthetists are requiring more pay. This is a barrier as more Medicare cases are being done in the ASC. The issue is that Medicare cases reimburse much less than commercial reimbursement. This puts a financial burden on the anesthesia department to pay for their CRNAs. I also believe that hospitals will mount a response and try to keep their operating rooms full. They will find ways to transition their ORs to a more outpatient friendly model.
Charles Claps, DO. Orthopedic Surgeon at Resurgens Orthopaedics (Acworth, Ga.): Absolutely bright. Providers and administrators understand and are experiencing that surgery is rapidly moving toward ASCs. Entrepreneurial physicians will continue to build and expand their ASC footprint through independent ownership or joint-venture partnerships with healthcare systems and third-party investors such as private equity. This trend will steadily rise over the coming years as insurers learn the cost savings that ASCs bring, in addition to the elevated quality of care that patients experience at physician-owned centers.
Corey Welchlin, DO. Orthopedist at United Hospital District (Fairmont, Minn.): I believe the outlook for independent ASC survival is bright, if the owners/management is creative with cash pricing options and networking with area surgeons to make the ASC as attractive as possible to use. We give nonowners their choice of start times and promote them to our patient base to add value to their visits.
Craig Popp, MD. Orthopedic Surgeon at Vero Orthopaedics (Vero Beach, Fla.): Independent surgery centers will continue to remain strong, but they will face many obstacles which include decreased reimbursements, medical necessity and cost constraints. Decreased reimbursements from payers from conventional insurance, workmen's compensation and self-pay will place additional stress on independent firms. Collaborations with larger entities that may have improved reimbursement rates and the ability to leverage resources will affect the landscape.
Dave Atteberry, MD. Neurosurgeon at Yakima Valley Memorial Hospital (Yakima, Wash.): Independent ASCs will always have a role to play in the access to healthcare. Their challenge and potentially a benefit will be in payer contracting. Large insurance companies ignore their requests for contracts; this allows one to build a local stronghold of patients and operate out of network, which can be of benefit.
Dean Karahalios, MD. Neurosurgeon at Advocate Health Care (Downers Grove, Ill.): Overall, my outlook for independent ASCs is bright. Demands for quality, efficiency, better patient experiences, physician satisfaction and third-party payer influence will continue to drive growth. This outlook is somewhat tempered, especially in neurosurgery, by the trend towards increased hospital system employment of physicians. In the short term, there will be pressure on the employed physician to maintain volumes in more costly traditional hospital-based venues. As hospital systems deepen their investment in their own ASCs, we will likely see a shift of more volumes to the ambulatory side.
Frank Phillips, MD. Spine Surgeon at Midwest Orthopaedics at Rush (Chicago): I believe the future of ASCs for spinal surgery is bright. Currently, lumbar decompression and anterior cervical procedures are the majority of spine cases performed in ASCs. I have performed lumbar fusions in ASCs for the past decade with successful outcomes and high patient satisfaction. As enabling technologies that are not prohibitively expensive evolve, surgeons will feel confident moving lumbar fusions and more complex cases from hospitals to ASCs.
Ganesh Ramoutar. Chief Procurement Officer at Advanced Pain Care (Round Rock, Texas): Outlook for independent ASCs is dim in my opinion, based on specialty and volume. Increased expense in people, medical supplies, drugs and equipment can easily be out of control. Centers that are not well organized and do not have seasoned leadership will or are taking a hit financially.
George Cybulski, MD. Neurosurgeon at Northwestern Medicine (Chicago): ASCs offer the most hopeful opportunity to develop and display ways to create true value in healthcare delivery. Due to their independence, management of ASCs must be not only diligent to the efficiency of their operations, they must be open to innovation for improving access to their services, demonstration of quality and efficiency over the competition. Independent ASCs must use their advantages in implementing innovation over the ponderous decision-making process of ASCs of big corporations or health systems.
Eric Mehlberg, MD. Pain Management Specialist at Comprehensive Pain Specialists (Broomfield, Colo.): Fully independent ASCs will continue to struggle in the coming years as more physician owners are becoming hospital employed. This will incentivize the doctors to take cases to ASCs with majority hospital ownership, if they are offered buy-ins at all. I believe local partnership with regional centers will be required, but the terms might feel too onerous for historically independent ASCs.
Hans Van Lancker, MD. Network Chief of Orthopedics at Cambridge (Mass.) Health Alliance: I'd say the outlook is gray. While it's very apparent outpatient surgery is more and more the future, the ASC boom is slowing and the large-scale investment in them by private equity and large systems doesn't seem to be enhancing their use or growth. Locally we have seen contraction of surgery back into hospitals in order to maintain their financial viability. We need to take what we've learned from ASCs on how to efficiently provide surgical care at the highest quality and consistency and, with that as a foundation, design a better hospital. In their current design, ASCs are pulling away some of the highest revenue care from community hospitals. We still need community hospitals as a foundation for healthcare in our country, so a better solution is essential.
Harel Deutsch, MD. Neurosurgeon at Midwest Orthopaedics at Rush (Chicago): I believe the outlook for ASCs is bright. ASCs are much more efficient than hospitals in terms of cost structures. I have heard of insurance companies mandating that patients go to ASCs due to cost issues. Surgeons are increasingly adopting more minimally invasive procedures that extend the realm of what is possible in the ASC setting. Previously, no spine surgeries were considered possible in the ASC setting. The incentive structure for physicians is aligned with the ASC setting.
Jacob Rodman. CEO at Raleigh (N.C.) Neurosurgical Clinic: Our outlook is extremely bright for independent ASCs. We believe the cost savings that can be achieved for patients, along with ease of access and focused skilled staff, truly sets independent ASCs apart from the rest.
James Chen, MD. Surgeon at Advanced Orthopedics & Sports Medicine (San Francisco): Independent ASCs will continue to grow in popularity and number. Particularly ASCs that focus on a specific specialty, such as orthopedic surgery, allow for efficient and cost-effective care through alignment of surgeon protocols, staff, resource management and patient care, which can be difficult in a large hospital setting. It will be important to maintain high quality of care as more ASCs are developed, which is where enabling episodes of care-based technologies can help standardize care delivery.
James Loging, MD. Orthopedic Surgeon at Palmetto Bone and Joint (Chapin, S.C.): Independent ambulatory surgery centers are a growing trend in healthcare, and their outlook is bright for several reasons. First, the demand for outpatient surgery is increasing. Patients are looking for ways to receive high-quality care in a more convenient setting, and ambulatory surgery centers are well-positioned to meet this demand. These centers offer a less expensive and more efficient alternative to hospital care, which is especially important for procedures that don't require an overnight stay. Patients can receive the same level of care they would receive in a hospital, but in a more comfortable and less intimidating environment.
Second, the rising costs of hospital care are driving patients away from traditional hospital settings. Hospitals are expensive to operate, and patients are increasingly looking for ways to reduce their healthcare costs. ASCs are able to offer the same level of care at a lower cost, making them a more attractive option for patients. This is good news for independent centers because they can provide this service at a lower cost than hospitals, making them more competitive.
Third, advances in medical technology are making it possible for more procedures to be performed in an outpatient setting. Many procedures that used to require an overnight stay such as hip and knee replacements can now be performed on an outpatient basis, thanks to advances in medical technology. This is good news for ASCs because it means they can offer a wider range of services to patients.
Fourth, the regulatory environment is becoming more favorable for ambulatory surgery centers. In recent years, there has been a push to reduce healthcare costs, and ASCs have been identified as a way to achieve this goal. As a result, there have been changes to the regulatory environment that make it easier for these centers to operate. For example, some states have eliminated certificate-of-need requirements, which makes it easier for new centers to open.
Finally, the COVID-19 pandemic has highlighted the importance of ASCs. During the pandemic, many hospitals were overwhelmed with COVID-19 patients, which made it difficult for them to provide other types of care. ASCs were able to step in and provide some of this care, which helped to alleviate the burden on hospitals. This has increased awareness of the important role that ASCs play in the healthcare system.
In conclusion, the outlook for independent ASCs is bright. These centers are well-positioned to meet the growing demand for outpatient surgery, and they are able to offer this service at a lower cost than hospitals. Advances in medical technology are making it possible for more procedures to be performed in an outpatient setting, and the regulatory environment is becoming more favorable for these centers. Finally, the COVID-19 pandemic has highlighted the importance of ASCs, which has increased awareness of the important role they play in the healthcare system.
Jami Osterlund. Director of Surgical Services at Hill Country Surgery Center (Cedar Park, Texas): I feel that the outlook for the independent ASC is harder, but not necessarily dark. It is harder for them to stay competitive with insurance contract negotiations for reimbursement, buying power from suppliers and vendors or maintaining competitive staff wages due to the limited resources available to solely physician-owned organizations. I have had previous experience in both an independently owned ASC and a joint-venture ASCs and have witnessed firsthand the positives and challenges of both.
Jayesh Dayal, MD. Pain Management Specialist at MedStar Montgomery Medical Center (Rockville, Md.): Independent ASCs, the panacea for MDs to control all aspects of their surgery, from design of the facility, scheduling, day-to-day operations, billing and supplementing their income — the true pride of ownership, and independence from hospital bureaucracy that motivated most MDs — is fast slipping away as the downward pressure on reimbursements in the face of rising cost, supply chain issues, staff shortages, etc., force MDs to seek partnerships with private equity and health systems that have access to higher reimbursements at hospital outpatient department rates and in general have the heft to negotiate better reimbursement from insurers. The days of independent ASCs are numbered, and that is tragic as independent ASCs are the right answer to the current healthcare woes on so many levels.
Jeremy Steinberger, MD. Director of Minimally Invasive Spine Surgery at Mount Sinai Health System (New York City): Bright. I think with the combination of spine surgeries getting progressively less invasive and technology improving in efficiency and cost, ASC utilization is going to continue to increase.
John Prunskis, MD. CEO and Medical Director at the Illinois Pain & Spine Institute (Elgin): There is a bright future for ASCs. As more and more members of Congress recognize the savings to Medicare and healthcare in general from performing cases in an ASC, this will only have a beneficial effect for ASCs. There should be parity between reimbursements for identical procedures, whether performed in hospitals or ASCs. This will help save Medicare from financial difficulty.
Joshua Rosenow, MD. Director of Functional Neurosurgery at Northwestern Medicine (Chicago): The outlook for independent ASCs is mixed. While there have been incentives to move cases to the efficient settings of ASCs, and physicians are very interested in both practicing in these settings and investing in them, the regulatory requirements surrounding ASCs continue to increase. Moreover, it is often challenging for physicians to be good at the clinical, business development and regulatory aspects of an ASC, making it easier to partner with a national management company rather than going it independently.
Katherine Wagner, MD. Neurosurgeon at Ventura (Calif.) Neurosurgery: My outlook on ASCs is quite bullish. They provide patients with a safe and efficient experience while keeping costs reasonable and help keep hospital beds and resources open for patients who truly need hospital-level care while providing excellent care for surgical patients.
Khawar Siddique, MD. Neurosurgeon and Co-CEO at Docs Health (Los Angeles): From a utilization standpoint, ASCs (independent and corporate/hospital owned) have a bright future. Gone are the days where third-party insurers and some older physicians actively discouraged surgical cases in an ASC setting. After much prodding, insurers and physician naysayers have finally accepted that ASCs have the advantages of one, cost; two, lower morbidity rates; and three, better customer experience. Underlying that switch of surgical cases from hospital to ASC is better surgeon training and the improved predictability of outcomes due to the improvement in technology.
From a reimbursement standpoint, independent ASCs are in trouble. Third-party insurers are cutting rates so dramatically that independent ASCs now have a lower operating margin and consequently higher chance of bankruptcy. Quite frankly, third-party insurers have a strategy that is short-sighted. By squeezing independent ASCs (and practices), third-party insurers are increasing the chance that independent contractors will join a corporate entity. That corporate entity will then have better negotiating leverage than the independents and will cause higher costs for third-party insurers and the nation. I urge third-party insurers to bet on independent healthcare entities as the best strategy to improve outcomes and reduce healthcare costs.
Lorraine Hutzler. Associate Program Director at the Center for Quality and Patient Safety at NYU Hospital for Orthopedic Surgery (New York City): With competition, increasing costs and workforce shortages, it will be hard for independent ASCs to be successful. Many will be bought up and integrated into larger healthcare networks or seek funding from private equity groups.
Lucia Zamorano, MD. Neurosurgery Professor at Oakland University William Beaumont School of Medicine (Rochester, Mich.): Dark due to the economy and lower reimbursements.
Michael Redler, MD. Surgeon at Connecticut Orthopaedics (Hamden): My outlook for independent ASCs is partly sunny. Independent ASCs still have the opportunity to demonstrate outstanding value for patients and insurers. Their ability to negotiate with certain payers may be more challenging based on more finite size. However, having said that, a well-run ASC with a dedicated staff, outstanding surgeons and involved administration still has the opportunity to come out on top in almost all markets. The challenge will always be to demonstrate that value when in competition with some of the bigger well-managed ASC companies.
Mick Perez-Cruet, MD. Professor and Vice Chair of the Department of Neurosurgery at Oakland University William Beaumont School of Medicine (Rochester, Mich.): I believe the outlook for independent ASCs is bright. The primary reason is doctors realizing financial independence, choice of implants and surgical efficiency. A shift towards minimally invasive spine surgical procedures and more effective postoperative pain control is allowing even complex spine procedures to be performed at the ASC. Increasing cost control and patients' desire to go home the same day is also leading to more spine procedures performed at the ASC.
Nicholas Street, MSN, RN. Self-Employed Travel Nurse. I believe the future for independent ASCs is bright. There are a number of factors that are driving this trend, including:
- The increasing demand for outpatient surgery. As the population ages and the cost of healthcare continues to rise, more and more people are choosing to have their surgeries done in an outpatient setting. ASCs offer a number of advantages over hospitals, including lower costs, shorter wait times and a more convenient experience for patients.
- The growth of ASCs. The number of ASCs in the United States has been growing steadily in recent years, and this trend is expected to continue. As more and more ASCs open, they will provide more competition for hospitals, which will help to keep costs down.
- The increasing acceptance of ASCs by insurance companies. In the past, some insurance companies were reluctant to cover procedures that were done in ASCs. However, this is changing as more and more evidence shows that ASCs are just as safe and effective as hospitals. As a result, more and more insurance companies are now covering procedures that can be done in an ASC.
Of course, there are also some challenges that independent ASCs face. One of the biggest challenges is the rising cost of healthcare. As the cost of healthcare continues to rise, it can be difficult for ASCs to keep their costs down. Another challenge is the increasing competition from hospitals and other ASCs. However, I believe that the advantages of ASCs will continue to outweigh the challenges, and I believe that the future for independent ASCs is bright.
Randall Zarin. Chief Strategy Officer of Orthopedics at the University of Texas Health Science Center at Houston: Several challenges over the last few years have been present in our ASC environment. Staffing issues, payer pressures and COVID-19 have all impacted our operations. However, we remain bullish on our ASCs when taking these challenges into consideration and addressing them from the start. I prefer to have our ASCs structured as single-speciality for efficiency, easier staff recruitment so we get the nurses and techs that want to practice in that facility and specialize, and creating more of a physician-friendly environment, all while maintaining a patient-friendly atmosphere. COVID has driven more volume to the ASCs over the last few years, and technology advancements have allowed us to move more from the hospital to the ASC.
Rick White, MD. Fitzgibbon Orthopedics & Sports Medicine (Marshall, Mo.): The outlook for independent ASCs appears to be bright. Advancements in technology and medical procedures are making more complex surgeries feasible in ASCs. This is attracting more patients who prefer the convenience of outpatient surgeries and the personalized care that ASCs provide. However, there are also challenges that independent ASCs face, such as regulatory compliance, reimbursement rates and competition from hospitals and larger healthcare systems. These factors can affect the financial viability and sustainability of independent ASCs.
Roland Kent, MD. Spine Surgeon at Northwest Specialty Hospital (Post Falls, Idaho): The future of spine surgery in the ASC is really dependent on how responsibly we use the ASC. Being realistic and responsible about the cases and the patients that we can successfully bring to the ASC will determine the brightness of our future in the outpatient surgical setting. Know your patients and know your limitations.
Steve Lucey, MD. Sports Medicine Specialist at Atrium Health/Wake Forest Baptist (Greensboro, N.C.): My outlook for independent ASCs is VERY bright! With a shift towards value-based care, more and more surgical services will migrate towards the ASC setting. And as an outpatient total joint surgeon, we are moving the vast majority of my cases into the ASC.
Thomas Feldman. CEO at Center for Health Ambulatory Surgery Center (Peoria, Ill.): I think that it is bright. As we continue to see costs rise, ASCs are positioned better to offer a more affordable option for the exact same procedural offerings. That isn't to say that ASCs should be reimbursed at a considerably lower rate by commercial carriers or CMS, but the reality is that they are. We do still have to pay the medical supply expenses similar to hospitals but don't have to run a 24-hour operation, so that assists in mitigating some of the disparity in payments.
Thomas Scully, MD. Neurosurgeon at Northwest Medical Center (Tucson, Ariz.): My outlook for ASCs vacillates week to week. We certainly can now do an increased variety of neurosurgical and orthopedic procedures at our ASC. This leads to optimism. Outcomes with fewer infections and happier patients are plentiful. However, anesthesia shortages combined with hospital system shenanigans can impact our ability to continue to grow.
Timothy Lubenow, MD. Anesthesiologist at Rush Pain Center (Chicago): The outlook for independent ASCs is bright because the growing population of baby boomers is entering their sixth decade of life. There will be more patients who need orthopedic, spinal and interventional pain management procedures.
There is a desire from most of these people to be able to remain active and participate more fully in physical activity as a means of managing health problems. This is different from previous generations. As such, there will be an abundance of patients. Independent ASCs have a bright future for several reasons. Firstly, they offer a cost-effective alternative to traditional hospital settings. ASCs are designed specifically for outpatient surgical procedures, allowing for streamlined processes and lower overhead costs. As a result, patients can often receive the same high-quality care at a fraction of the cost compared to hospitals.
Secondly, independent ASCs are known for their time efficiency. These centers focus on performing specific procedures and prioritize efficient patient turnover. With dedicated surgical teams and specialized equipment, ASCs can minimize wait times and optimize scheduling, leading to faster procedures and reduced patient time spent in the facility.
Moreover, independent ASCs are able to provide personalized care and a patient-centric experience. With a narrower scope of services, ASCs can concentrate on delivering excellent care for specific procedures, leading to improved patient outcomes and satisfaction. Patients often appreciate the individual attention and specialized expertise that ASCs can offer.
Furthermore, independent ASCs contribute to the overall healthcare system by relieving the burden on hospitals. By redirecting low-risk surgeries to ASCs, hospitals can focus their resources on more complex cases, emergency care and critical medical services. This optimization leads to enhanced efficiency across the healthcare system and improved access to care for all patients.
Lastly, technological advancements have further propelled the growth of independent ASCs. Innovations such as minimally invasive procedures, improved anesthesia techniques and enhanced surgical tools have made many surgeries suitable for the outpatient setting. ASCs are at the forefront of adopting these advancements, providing patients with cutting-edge treatments in a comfortable and convenient environment.
In summary, independent ASCs have a bright future due to their cost effectiveness, time efficiency, personalized care, contribution to the healthcare system and integration of technological advancements. These centers offer patients a compelling alternative to traditional hospital settings, ensuring high-quality care while maximizing convenience and accessibility.
Todd Lansford, MD. South Carolina Sports Medicine (Charleston): The future is very bright for surgery centers. More and more cases are being transferred to them. Insurance companies are recognizing the cost benefits and encouraging their use. And patients love it. There is nothing but growth for surgery centers.
Tony Tsismenakis, MD. Orthopedic Surgeon at DownEast Orthopedics (Bangor, Maine): My outlook for independent ASCs is very bright. An increasing amount of procedures are being removed from inpatient-only lists and already have been in orthopedics. Total joints, for example, used to be in-hospital surgeries with multiday stays and possible discharges to nursing homes. In a short period of time and with cutting edge techniques and protocols, we have been able to safely transition to a primarily outpatient operation, with more and more performed at the independent ASC.
Troy Morrison, DO. Orthopedic Surgeon at Citizens Memorial Healthcare (Bolivar, Mo.): Bright! In our current climate of healthcare, cost containment is the driving force for survivorship and profitability. Independent ASCs are structured to run efficiently, which gives them an advantage over large health systems, which can be top heavy and less agile.
Tung Ha, DO. Neurosurgeon at PeaceHealth St. Joseph Medical Center (Bellingham, Wash.): There is an epidemic in healthcare. In the media it is labeled as "physician burnout," but I do not believe that this is the best phrase to describe the problem. I think the term "physician learned helplessness" is more accurate. It's a given that the surgeon is responsible for the outcome of surgery. Therefore, I cannot imagine a more demoralizing way to practice medicine than to be responsible (and medically liable) for outcomes beyond my control or to answer to a hospital administrator with minimal clinical knowledge. For our group, the solution to this problem was to create the Cascade Outpatient Spine Center in Bellingham, Wash. As a neurosurgeon who serves as the medical director and owns and operates an ASC dedicated to spine care, I absolutely love my job. Our group can exercise maximal control over every aspect of surgery: patient selection, insurance authorization, staffing, equipment and implants. We can surround ourselves with top-notch administrative and clinical staff that we care for like family. We can equip ourselves with the state-of-the-art tools of the trade. If we want to use a new device or implant, we can make this command decision immediately instead of submitting the request before a hospital committee for a cost analysis and deliberation for six months. The outcome of this positive control is an optimized surgical outcome, patient experience and surgeon experience. With payers encouraging and often requiring procedures to be performed on an outpatient basis, our volume has grown year after year.
Yet, be forewarned: Where there is full autonomy, there is full accountability. To run a successful center, I have found the mindset of extreme ownership to be essential. If you want control of everything that happens in your practice (and life), you need to be responsible for everything as well. It begins with you and ends with you. Having said that, I would rather own 40 acres and a mule than work for the plantation any day. Working half as much, making twice as much, and loving your job and life is my dream come true. The future of independent ASCs can be very bright.
Vishal Mehta, MD. President and Managing Partner at Fox Valley Orthopedics (Geneva, Ill.): My outlook for independent ASCs is very bright. I believe that the trend of moving higher acuity procedures such as joints and spine will continue to pick up speed. In addition, I believe the labor market issues will continue to improve and that independent ASCs are often better positioned to be nimble and efficiently respond to market changes.
Vivek Babaria, DO. Founder and Interventional Spine Physician at Orange County Spine & Sports Medicine (Newport Beach, Calif.): Bright! Value-based models and hospital systems that are employing physicians have a problem of delivering timely service. With an aging population, advances in medical technology and increasing healthcare needs, patients and payers are increasingly seeking cost-effective and convenient alternatives to hospital-based care, and ASCs can provide such options. The obvious challenges are regulatory compliance, reimbursement/contractual issues and rising costs. If you have a good understanding of your payer mix and your local market, there is a bright future.
Yeshvant Navalgund, MD. Pain Management Specialist at National Spine & Pain Centers (Glen Burnie, Md.): The increasing demand for ASC services and the growing trend towards value-based care are positive for independent ASCs. Ultimately, the outlook for independent ASCs will depend on their ability to adapt to changing market conditions, provide high-quality care and maintain a competitive edge. A lack of demand will certainly not be a reason for failure.