Why ASC leaders are looking to spine 


Spine and orthopedics have been a gold mine for ASCs in the last few years as technology advances and procedures continue to be approved for the outpatient setting. 

Patients are drawn to ASCs and outpatient procedures for faster recovery times and an ability to recover from procedures at home. More than 190 ASCs in the country now offer minimally invasive spine surgery, according to 2022 data from Newport Beach, Calif.-based Hoag Orthopedics.

Developing these service lines can draw volume and revenue to ASCs. 

"As an orthopedic CEO and practicing surgeon, I've witnessed firsthand the transformative impact of outpatient hip and knee arthroplasty on our surgery centers," David Jevsevar, MD, CEO of OrthoVirginia, told Becker's in September. "These procedures significantly enhance our center's efficiency, allowing us to treat more patients without the need for extended hospital stays. This not only streamlines our operations but also translates to a notable reduction in overhead costs associated with prolonged inpatient care."

The addition and development of hip and knee arthroscopy has "diversified our service offerings, positioning our centers at the forefront of innovative, patient-centric orthopedic care," he added. 

The volume of orthopedic procedures in the outpatient setting is 33 times higher than the volume of inpatient procedures, according to an American Joint Replacement Registry's 2023 annual report. The number of knee replacement procedures in the outpatient setting has also increased by 293% from 2019 to 2023. 

Additionally, the margins for hip and knee replacements in the outpatient setting are much more favorable than in the inpatient setting. Per-case margins also have consistently decreased for hospitals in the inpatient setting while increasing in the outpatient setting. 

"The past decade has shown us that orthopedic and spine surgery (in the properly indicated patient) can be performed in a safer, more efficient and cost-saving manner compared to the traditional large hospital setting," Philip Louie, MD, a spine surgeon and medical director of research and academics at Virginia Mason Franciscan Health's Center for Neurosciences and Spine in Seattle, told Becker's. "This migration of surgeries to the ambulatory surgery centers and other outpatient centers have been fueled by the innovation of several enabling technologies."

It will be "paramount" for hospitals and other larger providers to look to ASCs amid financial stressors, he added. 

This trend is not likely to slow down. CMS recently added 11 procedures to the ASC-covered list that were not included in the proposed rule, including total shoulder arthroscopy and four other orthopedic codes. 

"With CMS' sudden unexpected release of total shoulder arthroscopy to the ASC-covered procedures list, I find myself scrambling to meet with our surgeons and staff to begin planning for the first of the year," Alfonso del Granado, administrator and CEO of Lubbock, Texas-based Covenant High Plains Surgery Centers, told Becker's

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