Reimbursement lags behind innovation in orthopedic ASCs

Orthopedic ASCs face a unique set of challenges. 

Kyle Anderson, vice president of finance and ASC at Ortho Rhode Island in Warwick, spoke with Becker's to discuss the biggest challenge orthopedic ASCs are up against today.

Note: This response has been lightly edited for length and clarity.

Question: What is the biggest challenge orthopedic ASCs face today?

Kyle Anderson: I would say the answer to that question actually relates in part to one of the reasons that it's so popular. The case migration as these complex orthopedic cases come from the hospitals and the innovation, whether or not it's based on the technology or whether or not it's clinical efficiencies, is very effective in pulling those cases from the hospitals. But the paradigm is that the payment system lags the innovation. So when you think about performing those same cases in an environment that traditionally has lower reimbursement but has all of the identical requirements of the case — meaning from a staffing standpoint, from an equipment standpoint, from an implant standpoint — you need to make sure that those two things are aligned. I think what we're seeing in the marketplace right now is the ability to perform these cases in an ASC setting has outpaced the financial reward for that innovation, which sort of puts a slight imbalance in the system that way. But truthfully, everyone wants this. The patients want it, the providers want it, it's more efficient, it's a better experience. I think healthcare economics is just a challenging arena that I definitely don't have the exact answer for. I know that ASCs provide a tremendous amount of value, and so it will be important for them to experience that reward economically.

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