Hospitals and ASCs have spent years competing for surgical volume. Now, some are discovering that the economics of spine and orthopedic care increasingly favor working together.
As more complex procedures move out of hospitals, health systems are seeking outpatient capacity, surgery centers are looking to expand their physician networks, and surgeons are facing reimbursement pressures that make efficiency increasingly important.
Lee Levanduski, CEO of healthcare management company TriasMD and Newport Beach, Calif.-based DISC Surgery Centers, which operates multiple outpatient facilities, sees those interests converging in a growing number of hospital-ASC partnerships.
“It’s nothing new, but it is accelerating for sure,” he told Becker’s.
One of those partnerships involves DISC’s surgery center in Carlsbad, Calif., which announced an agreement with San Diego-based Sharp HealthCare Sept. 30. Sharp took an equity stake in the facility, now branded Sharp DISC Surgery Center Carlsbad, expanding access for its affiliated surgeons to an outpatient center performing endoscopic spine surgery.
The arrangement illustrates a changing competitive dynamic: Rather than losing surgical volume entirely when procedures leave the hospital, health systems are finding ways to participate in the outpatient market alongside specialized ASC operators.
When competitors become partners
For Mr. Levanduski, the Sharp partnership began with an assessment of local demand.
“It starts with community and data,” he said. “The data shows that there’s opportunity to bring the highest quality orthopedic and spine care services to the population of the area.”
The agreement builds on DISC’s previous relationship with Oceanside, Calif.-based Tri-City Medical Center, now part of Sharp. It combines the health system’s physician network and clinical resources with DISC’s outpatient surgical infrastructure.
The organizations bring complementary strengths. Health systems can direct patients toward appropriate outpatient settings, while specialized ASCs offer surgical capacity designed around efficient procedures.
“Health systems can help drive access to surgery centers, while surgery centers can offer greater outpatient capacity than hospitals may be able to accommodate,” Mr. Levanduski said.
That alignment allows hospitals to preserve resources for patients requiring inpatient care while expanding outpatient options for appropriately selected cases. Mr. Levanduski said the benefits extend to surgeons, payers, employers and patients, not just the organizations sharing ownership.
From five days to a few hours
Mr. Levanduski has witnessed how dramatically the boundaries of outpatient surgery have shifted. He remembers when total joint replacements routinely required three to five days in the hospital. Procedures were often scheduled early in the week so patients could be discharged before the weekend. Today, many appropriately selected patients return home within hours.
The transformation reflects advances in surgical techniques, technology and the ability to identify patients who can recover safely outside a hospital.
“We’ve come a long way with technology,” he said. “We’ve come a long way with physician surgeon skill, and we’ve come a long way with predictive analysis of who the right patient is.”
Those advances have expanded what specialized ASCs can perform, but Mr. Levanduski cautioned that technical capability does not automatically make a procedure appropriate for every patient.
“Not every procedure or level of care is appropriate for ASCs,” he said.
Patient selection begins with the surgeon and patient, accounting for comorbidities, body mass index and potential complications. Surgeons, anesthesia providers and medical directors collaborate when additional review is needed.
DISC’s ability to accommodate postoperative stays of up to 23 hours supports more complex procedures requiring extended observation. Its centers can also bring in co-surgeons, including vascular specialists, and use equipment such as surgical microscopes, fluoroscopy and specialized operating tables.
As outpatient spine surgery becomes more sophisticated, the challenge is not simply expanding what can be performed outside the hospital. It is determining which patients can safely benefit from that expansion.
The surgery is only part of the equation
The Sharp-DISC partnership extends beyond operating room access. The organizations are also working to coordinate imaging, diagnostics, preoperative clearances, rehabilitation and follow-up care.
“It certainly is a value chain, and it takes a village,” Mr. Levanduski said.
Patients may begin with conservative treatments such as physical therapy or injections before being referred for surgical evaluation. Once surgery is recommended, medical clearances, recovery arrangements and postoperative services must be coordinated across multiple providers. A shorter surgical stay makes that coordination especially important.
“Postoperative follow-up is critical,” Mr. Levanduski said. “There’s a good argument that care really begins with surgery.”
For hospital-ASC partnerships, the opportunity extends beyond increasing procedural volume. Integrating services can reduce fragmentation and help patients navigate the transition from surgical evaluation through recovery. Mr. Levanduski also emphasized the importance of recognizing how differently patients and clinicians experience surgery.
“A back or a knee surgery is probably the first time for the patient,” he said. “It’s something that our physicians and surgeons and staff do day in and day out.” That distinction, he said, makes empathy and continuity of care essential parts of the outpatient experience.
Reimbursement pressure changes the calculation
The growth of hospital-ASC partnerships comes as orthopedic surgeons confront uncertainty over federal reimbursement.
With CMS preparing to finalize its 2027 physician payment policies, Mr. Levanduski said projected reductions in professional fees are making efficient surgical environments increasingly important. He expressed particular concern about the financial pressure facing joint replacement surgeons, arguing that practices have less room to absorb operational inefficiencies as reimbursement tightens.
Surgeons need to work in “as barrier-free of an environment” as possible, he said, allowing them to maintain productivity without unnecessary obstacles.
Although ASC partnerships cannot reverse reimbursement cuts, they can create opportunities to improve scheduling, operating room utilization and surgical throughput. For hospitals and surgery centers, those pressures strengthen the case for sharing resources rather than competing for every procedure.
A new division of surgical care
Mr. Levanduski expects hospital-ASC partnerships to accelerate as both sides recognize the advantages of combining their resources.
Hospitals will remain essential for patients requiring complex medical management and inpatient care, while specialized ASCs take on a growing range of procedures that can be safely performed outside the hospital.
The Sharp-DISC partnership illustrates how that division can evolve into a more collaborative model, with health systems and outpatient operators sharing resources, expanding surgical capacity and coordinating care across settings.
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.
