As ASC industry booms, hospitals look to outpatient models

It's no secret that orthopedic care is one of many specialties migrating to the outpatient setting, and hospitals and health systems are making several strategic shifts to keep up with this trend.

CMS and commercial payers are adopting policies that encourage providers to perform specialty procedures in the outpatient setting, where such services can be performed at a lower cost than the hospital inpatient environment.

Recent advances in minimally invasive technologies have also allowed for more complex procedures — such as spinal fusion and hip and knee replacements — to be performed safely at ASCs and hospital outpatient departments, with patients going home the same day. 

To keep up with this shift, specialty hospitals and surgeons are investing in minimally invasive technologies like robotics, augmented reality systems and endoscopy, which allow for complex spine and orthopedic surgeries to be done safely in the outpatient setting. Reduced blood loss, fewer complications and increased patient satisfaction are some of the many benefits associated with these technologies.

The cost differential between services provided in inpatient and outpatient settings is a major driving factor as U.S. healthcare spending approaches $6.2 trillion, accounting for nearly 20 percent of the gross domestic product

"Hospitals have negotiated against surgery centers for decades, leading to a dramatic difference in hospital, hospital outpatient department and ASC reimbursement," Adam Bruggeman, MD, CMO of MpowerHealth in Addison, Texas, told Becker's. "These practices and policies are driving a significant component of the outpatient migration, in addition to legislation that prevents new physician-owned hospitals from being developed de novo."

Some surgeons question if this healthcare renaissance will signal the end of hospitals as we know them, where bottom lines are increasingly plagued by staffing shortages and the continued effects of COVID-19. Many believe that spine and orthopedic surgeries, which historically required lengthy overnight stays, will only be performed in the hospital on elderly patients with complex cases and significant comorbidities.

"By 2030, I expect we will determine the criteria for same-day surgery and those that require a hospital stay, likely patients with comorbidities," according to Srdjan Mirkovic, MD, of Chicago-based NorthShore Orthopaedic & Spine Institute in Skokie, Ill. "We would have to rethink remote care and the extensive support system required to accommodate an outpatient surgery for a patient with conditions such as diabetes, hypertension and obesity."

Hospitals and health systems across the country are revamping outpatient strategies, building ASCs and affiliating with surgeons to jointly operate surgery centers. Some specialty hospitals are also shifting to outpatient models.

Shriners Hospitals for Children in Springfield, Mass., a pediatric orthopedic facility, announced in April that it will close its inpatient beds and convert to an outpatient clinic model, following its earlier decision to close an outpatient orthopedic hospital in Tampa because of challenges associated with providing only specialty care in the area.

The rising cost of the U.S. healthcare system demands providers pursue rational ways to provide high-quality, high-value care, with physician-owned and -run ASCs having a clear role to play in evolving the healthcare system to a more sustainable future.

"Reputations of hospitals will need to be earned, rather than reliant upon a name or affiliation," according to Brian Gantwerker, MD, of the Craniospinal Center of Los Angeles. "The hospital lobby will need to somehow stop the hemorrhage of cases by getting Congress to pay them more for their more acute cases or to make it harder for private ASCs to do business. But the only way in a free market for them to stay competitive, is to build efficient outpatient centers and allow physicians to have leadership roles and to take the lead in terms of team building, [operating room] efficiency and to hold everyone accountable."

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