Migration of trauma procedures into ASCs is a future focused on value
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Health care systems have been pushed for years to find new and innovative ways to bring value back into the operating room, yet little change has been initiated by many hospitals and administrations.
This lack of progress in the inpatient setting has inspired a generation of ASCs, driven in part by physicians, to emerge. According to the Ambulatory Surgery Center Association, 90% of ASCs are partially physician-owned in the United States, and 64% are completely physician-owned. In looking at this movement, the cost comparison between hospitals and outpatient settings is the most influential factor motivating change. ASCs are associated with significantly lower procedural costs, often equating to half the costs of hospital counterparts. With other influences, such as opportunities to hold impactful leadership roles, increased authority in decision-making, additional financial drivers and greater operational awareness, surgeons are flocking to these centers. As this surge continues across the U.S., we are in the midst of a clear industry division between hospital and ASC operations. However, one thing is certain. ASCs are positioned to be the future of orthopedics.
Migration to ASCs
The migration into ASCs, while nonlinear and varying among states, is altering orthopedics for generations to come. Many health care systems will need to learn how to adapt to these changes. The massive costs associated with a growing population and the large variety of simple and complex procedures routed through hospitals, as well as the increase in injuries across every specialization, have made the OR one of the most financially unsustainable spaces within hospitals.
For now, these spaces will continue to manage high-risk cases revolving around the spine, urology, oncology and polytraumatic injuries as factors such as varying risk for procedural complications, higher mortality rates and preexisting conditions must be considered prior to initiating care. However, as high procedural costs trickle down into more common everyday cases, we will continue to witness the industry increasingly shift toward ASC-based procedures.
There is an array of benefits associated with ASCs that are attracting physicians and patients to this care model, including time savings, streamlined facility operations and same-day discharge. Research has demonstrated that ASCs are associated with lower risk for infection and are more efficient. The standard length of time between two surgeries is typically 30 minutes to 1 hour at a hospital; however, many ASCs require 15 minutes before the next procedure.
Same-day discharge is highly favored by patients utilizing the ASC route. Anesthesiologists at ASCs specialize in regional blocks requiring less narcotic use, resulting in less respiratory depression and often less postoperative pain, which allows patients to return home hours after their surgeries. Additionally, the accommodations offered at ASCs have improved through the introduction of “care suites” that are made available if a patient requires an overnight stay for further care or observation.
CMS price transparency
Occurring alongside the ASC migration are the new CMS price transparency requirements that aim to provide patients with the tools they need to compare procedural costs across hospitals and clinics so they can make the most educated decision before heading into the OR. As of Jan. 1, health care systems within the U.S. were required to publish the cost for their services and procedures. As CMS instills guidelines that, to a certain extent, now favor the use of ASCs over hospitals for an array of surgeries, the financial benefits of these facilities are more visible than ever before to patients, physicians, administrations and insurers.
Hospitals need to decrease costs to remain competitive, yet in assessing the last decade of operations within these systems, numerous imbalances remain in play. Hospital and physician revenue has been on a downward trajectory for the last several years, whereas the costs associated with orthopedic implants have increased or remained static during the same span of time. Addressing the financial drain associated with these implants will be an imperative step in determining where and how much value is being lost in each OR. Hospitals are still in the position to join this new generation of care.
Future ahead
For many systems, the construction of a hospital-affiliated ASC is in the works or has already begun. With any innovation or new practice, there often comes push back from members of the community who are not readily willing to embrace change. ASCs have not been immune to this backlash, as these facilities have been portrayed by some as greedy or unsafe. Combating these ideas will take time as some individuals do not connect the outpatient setting with value. A push for greater awareness around value-based initiatives and ASC advantages, as well as additional clinical research and more time, will help minimize these looming obstacles. Acknowledging the hard financial facts is what will help push orthopedics into a more sustainable and affordable future.
For years, patients and physicians had no clear idea of the financial implications of orthopedic surgeries, especially the costs associated with the implants being used. Surgeons operating within a hospital have no clear motivation to care about the cost of the implants because their reimbursement is not tied to the hospital’s reimbursement nor to the patient’s costs. However, when physicians are part-owners of surgery centers, they are fully aligned and rewarded for value-based clinical care.
Negotiations with manufacturers regarding the purchase of products have evolved to help ensure that ASCs can acquire affordable implants with outstanding clinical outcomes. In my case, the team at Reno Orthopaedic Center takes the specific prices we are willing to pay for implants directly to reps and determines which industry partners can meet our needs.
Taking the initiative to better align with value-based practices begins with ensuring patients receive the appropriate level of care. Otherwise, we are wasting time, resources and space that could be used for more urgent cases. By moving eligible surgeries to their appropriate level of care, we avoid wasting money and contributing to the increasing prices of other procedures. This is one way the migration into ASCs can elevate the implementation of value-based care for the betterment of patients, physicians and health care systems.
References:
Ambulatory Surgery Center Association 2017 Salary & Benefits Survey. www.ascassociation.org/asca/resourcecenter/benchmarking/employeesalaryandbenefitssurvey
Berríos-Torres SI, et al. JAMA Surg. 2017;doi:10.1001/jamasurg.2017.0904.
Owens PL, et al JAMA. 2014;doi:10.1001/jama.2014.4.
Munnich EL, et al. Health Aff (Millwood). 2014;doi:10.1377/hlthaff.2013.1281.
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