As spine and orthopedic procedures continue shifting outpatient, ASCs are managing rising case complexity, new technology expectations and tighter demands around patient experience and financial performance.
During Becker’s 31st Annual Meeting: The Business and Operations of ASCs in Chicago, four leaders discussed how they are approaching innovation and when to pump the brakes.
The panel featured Heather Colón, group chief executive officer of the Boynton Beach, Fla.-based Orthopedic Surgery Center of Palm Beach County and the Specialized Outpatient Surgery Center for Children and Adults; Jen Danner, BSN, RN, senior director of surgical services at Orlando (Fla.) Health Jewett Orthopedic Institute and Eugene Jewett, MD, Surgery Center; Brian Gantwerker, MD, spine surgeon and neurosurgeon at The Craniospinal Center of Los Angeles; and Brandon Hollis, vice president of operations at Nashville, Tenn.-based AmSurg.
Why spine and orthopedic cases are accelerating into ASCs
Panelists pointed to CMS activity, technology advancements and shifting patient preferences.
Mr. Hollis cited CMS’ anticipated outpatient rule, which may add more than 500 ASC codes, along with federal advocacy efforts such as ASC co-pay legislation. He added that COVID-19 accelerated patients’ comfort with outpatient surgery.
“I think COVID did the ASC industry a great favor in pushing people away from the hospitals,” he said.
Ms. Colón highlighted lower infection rates, anesthesia advances and streamlined discharge workflows as continued drivers. Still, all agreed clinical appropriateness and patient selection remain essential as cases grow more complex.
Innovation vs. safety: drawing the line
As more spine procedures move outpatient, panelists said the biggest barriers are surgeon expectations and comfort with complexity.
Ms. Danner said many neurosurgeons and spine surgeons want the same high-end navigation and robotic tools they use in hospitals and will not shift cases without them. Incorporating such technology requires multi-year planning and careful coordination around post-anesthesia care unit times and discharge criteria.
Dr. Gantwerker urged caution with both technology spending and case selection.
“Be careful about buying too many toys,” he said. “If it doesn’t make sense in an ASC, it just shouldn’t make sense.” He added that attempting a three-level transforaminal lumbar interbody fusion in an ASC “shouldn’t be done … maybe never in general.”
He also warned against the “democratization of spine surgery” enabled by advanced technologies, and said ASCs must vet surgeons and monitor complications closely.
Pediatrics and adults: similar expectations
Patients, whether pediatric or adult, want clear communication, reassurance and a calm environment, Ms. Colón said. “If they’re picking up on anxiety and rush … your patients are going to feed into that energy,” she said.
She advised simplifying clearances, financial discussions and discharge instructions — and ensuring patients do not feel they need to “call 15 different numbers” if they have a question.
When a hospital-grade EHR pays off
Epic is uncommon in ASCs, but Orlando Health’s orthopedic center adopted it.
Ms. Danner said she was hesitant about the cost at first, yet the platform has since enhanced pre-admission efficiency, imaging integration and communication with families.
“As soon as our case is done, those images are pushed out to the patient’s MyChart,” she said.
The center’s size — 55 operating physicians — and its integration with Orlando Health made the investment worthwhile, even if it took almost a year to see its full impact.
Strengthening the continuum of care
Panelists said coordination across the clinic, ASC and physical therapy remains a major opportunity.
Mr. Hollis noted the value of involving post-op physical therapists before surgery to set expectations. Ms. Colón said shared scheduling tools have improved communication between offices and ASCs, while Ms. Danner emphasized aligning leaders across all settings so patients receive consistent information.
Dr. Gantwerker added that fundamentals still matter most: thorough pre-op counseling, arranging home health and medications early, and training staff to triage concerns.
“Tech should just enable that. It shouldn’t drive it,” he said.
Building smarter partnerships
Mr. Hollis said AmSurg is shifting toward more flexible ownership models, rather than relying solely on the traditional 51/49 joint venture structure. The goal, he said, is to meet physicians where they are and support centers that want to grow, but may not have the resources or operational expertise to do so alone.
To guide technology decisions, AmSurg created a musculoskeletal physician advisory board that meets quarterly to evaluate new tools, identify worthwhile investments and recommend when to pump the brakes. Peer-driven data, he noted, is often far more persuasive to surgeons than directives from corporate leaders.
Vendor relationships are also evolving. Mr. Hollis said vendors must function as true partners — not just equipment suppliers — with shared responsibility for capital placement, staff education and driving appropriate case volume.
“If you don’t have vendors that are true partners with you, you need to find new vendors,” he said.
Panelists emphasized that these broader, more collaborative partnerships are becoming essential as ASCs take on higher-acuity orthopedic and spine cases and navigate rapid technological change.
