How New York hospitals are fighting payers to keep orthopedic procedures

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Executives from New York hospitals are fighting to keep profitable orthopedic procedures despite pressure from CMS and private payers to transition lower-acuity procedures to the ASC setting, Buffalo Business First reported Dec. 13.

One such executive is Joseph Ruffolo, CEO of Niagara Falls (N.Y.) Memorial Medical Center. The hospital recently entered into a partnership with Buffalo-based UBMD Orthopedics & Sports Medicine to have the practice provide sports medicine services to Niagara Falls-based Niagara University's sports program. The move was a strategic one to establish relationships with the group's surgeons and have them use the hospital for their orthopedic procedures.

The hospital's orthopedic service line has grown 10 percent year over year, Mr. Ruffolo said to the publication.

"The key to competing with [ASCs] is to make it very efficient and convenient for a joint replacement surgery," Mr. Ruffolo said. "They can go back and forth as if they were in an ambulatory surgery setting. That's the key for ortho docs."

COVID-19 was beneficial to the ASC industry as it accelerated procedure migration to ASC settings, which were largely isolated from COVID-19 cases. CMS, too, has seen the value of ASCs and continues to add more orthopedic procedures to the ASC payable list.

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