Two ASC leaders joined Becker's to discuss the payer trends that are affecting ASCs in the most significant ways at the moment.
Editor's note: These responses were edited lightly for length and clarity.
Anthony Bevilacqua, MD. Surgeon at Sports Medicine & Orthopaedic Center (Suffolk, Va.): In terms of the payer trend most affecting the surgery centers, I believe it's an ongoing and evolving problem of payers not covering needed implants. Surgeons will sometimes try to fix something by other means if implants are not available or covered by insurance. Since more complex problems are progressively shifting to outpatient areas, this problem is likely to worsen. It might be an appropriate time for consideration of conveying a portion of implant costs to the patient in terms of deductible as an alternative to denying them all together.
Anupam Pradhan, MD. Chair of Orthopedic Surgery at Southwest Joint Replacement and Sports Medicine (Dallas): As a surgeon who does a lot of shoulder arthroplasty, one of the highlights of this last year was having CMS approve shoulder arthroplasty for ambulatory surgery. When I think of my patient population, I see my patients recovering from shoulder replacement similarly to total knee and total hip replacement. The one advantage they have over patients that have lower extremity arthroplasty is that they can still walk and be mobile, which helps them be better candidates for outpatient surgery. I think the change was appropriate and probably overdue. This will help drive some of those patients to an outpatient setting.