As surgical reimbursements decline and more procedures shift to the outpatient setting, ASC ownership has become one of the most consequential financial decisions orthopedic surgeons face.
These three surgeons connected with Becker’s to share why they believe the case for ASC ownership has only grown stronger, and what it takes to make it work.
Ask Orthopedic Surgeons is a weekly series of questions posed to orthopedic surgeons and leaders around the country about clinical, business and policy issues affecting orthopedic care. Becker’s invites all orthopedic surgeons and specialists to respond.
Next question: What is the most overused procedure in orthopedics right now, and why does it persist?
Please send responses to Cameron Cortigiano at ccortigiano@beckershealthcare.com by 5 p.m. Central time July 20.
Editor’s note: These responses have been lightly edited for clarity and length.
Question: How are you thinking about outpatient surgery center ownership? Is it still the right investment, and why?
Jeffrey Carlson, MD. Orthopedic Spine Surgeon at Orthopaedic & Spine Center (Newport News, Va.): ASC investment is still a good long-term plan for an orthopedic practice. We have seen many surgeries move to the ASC as surgical techniques and anesthesia practices make the surgeries possible for the outpatient setting. As safety and experience improve in our practice of medicine, allowing patients to recover from surgery at home has increased the patient’s and family members’ satisfaction. More surgeries are being taken off the inpatient-only list that will further expand the surgical possibilities. As surgeons, being able to manage the patient care experience personally rather than accepting the hospital-controlled pathways has allowed us to give the best outcomes for our patients. Financially, as we have experienced reimbursements decreasing, investing in the ASC is one way to change the trajectory of declining wages. We have seen the fees increasing to hospitals over the past 20 years, while surgical fees continue to be reduced. If you are investing in an ASC that gives you the autonomy to direct the patient care, you join the facility portion of the reimbursement equation. Doing the same surgery for patients while being able to direct all aspects of surgical care and being fairly paid will certainly assist in combating burnout.
Elizabeth Matzkin, MD. Orthopedic Surgeon and Chief of Women’s Sports Medicine of Brigham and Women’s Hospital (Boston): ASCs are the right investment for a talented, efficient, high-volume and cost-conscious surgeon who wants more control of quality and patient experience.
Leo Spector, MD. Orthopedic Spine Surgeon and CEO of OrthoCarolina (Charlotte, N.C.): We remain very positive on ASCs, and I do not expect that to change. The case for ownership has only strengthened as more orthopedic procedures safely shift to the outpatient setting and as patients and payers continue to seek lower-cost, high-quality alternatives to traditional hospital-based care.
For OrthoCarolina, ASC ownership is central to how we deliver value. We intentionally sold our physical therapy and MRI businesses so we could redirect capital and organizational focus toward expanding our ASC footprint. The rationale was simple: if you try to be everything to everyone, you risk losing focus on what you do best. Our core business is orthopedic surgery and physiatry, and ASCs are increasingly the right setting to provide that care efficiently, accessibly and at scale.
Physician ownership is especially compelling because it creates direct alignment. The physicians shaping how an ASC operates are the same physicians caring for patients there. That accountability matters. It influences decisions about quality, efficiency and patient experience in ways that are difficult to replicate when physicians are simply technicians rather than owners and stakeholders.
Certificate of Need reform in North Carolina and South Carolina has been a true inflection point for us. For years, our ASC ownership structure was a patchwork of individual ownership through various partnerships with hospital systems, management companies or both because that was what the regulatory environment required. We can now build a more cohesive OrthoCarolina ASC strategy with consistent standards across the network. That is a fundamentally different kind of investment than we could make before, and we intend to take full advantage of it.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
