Hospitals vs. ASCs: What 3 spine surgeons expect as outpatient migration continues


While many surgical procedures have been steadily migrating from the inpatient to outpatient setting in recent years, the COVID-19 pandemic has accelerated this trend.

There are certain high-risk procedures that surgeons will likely never perform at outpatient settings, but hospitals are expected to alter their strategies and become more involved in ASCs as outpatient migration continues in the coming years.

Three spine surgeons share their thoughts on competition between sites of care, joint-venture partnerships and how outpatient migration has stifled innovation in orthopedics:

Note: Responses are lightly edited for style and clarity.

Jeffrey Carlson, MD. Orthopaedic & Spine Center (Newport News, Va.): I think hospitals will become more heavily involved at ASCs and partner with physicians to create these centers with a better patient experience. The patients are driving this. Physicians are having that direct patient care, understanding what the patients need and what the patient expectations are. A lot of patients, especially over the past year, don't want to have surgery at a hospital. That's something that physicians hear as they discuss surgery with their patients. Physicians having that direct patient care are able to guide that care and manage the needs of the patient.

Daniel Lieberman, MD. Phoenix Spine & Joint. Hospitals are not going to stay on the sidelines. They can't let their golden egg leave the goose. They're going to have to be heavily involved in ASCs, so they're going to be another stakeholder that will get even more fired up and involved in our industry.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Hospitals have been expecting this trend to come for a while. What is interesting is how it has slowed down innovation. For example, I approached a hospital in Las Vegas about purchasing a robot to perform minimally invasive spine surgery and increase volume at that hospital. But they expect to lose so many elective spine surgery cases over the next five years to ASCs and expect very little cases to be done in the hospital, so they didn't want to invest in the technology. That's somewhat of a defeatist attitude that I've seen some hospitals take. 

Other hospitals are investing in surgery centers so they can secure some profit from the partnership. Hospitals still have a lot of capital they can invest, where surgery centers are typically starved of capital, which is why it makes sense to partner. In my opinion, outpatient migration of spine surgery will encourage surgery centers to rent or purchase surgical robots and other advanced technology to drive that exodus even faster. 

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