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Conference Summary: Becker's 16th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference
posted: July 2, 2018
Edited by: Ross E. Weber
The theme of the June 2018 Becker’s Healthcare meeting dedicated to orthopedic-driven ambulatory surgery centers (ASC) was Improving Profits, Business and Legal Issues. The event provided an opportunity to meet orthopedic, spine and pain management surgeons, administrators and ASC owners and operators. One hundred and nine sessions, each lasting between 35 and 40 minutes, featured more than 222 speakers.
For most ASCs, lower reimbursements and increased operating expenses are tightening margins and challenging facilities to differentiate themselves while keeping costs low. In response, many ASCs have turned to ancillary services. According to James Lynch, MD a spinal neurosurgeon and founder of SpineNevada, “...independent practices should be working to distinguish themselves through [ancillary services] because they can provide them at a higher quality [than hospitals] for a lower cost...and a better experience for the patient.”
“For example,” Dr. Lynch continued, “if you work with physical therapists in your practice, you will be less likely to suggest surgical procedures for patients, and this ancillary service can save money for your practice.”1
Bundled payment programs are becoming increasingly popular among spine and orthopedic practices. These programs aim to improve care coordination, clinical outcomes and patient experience. At the conference, several sessions featured ASC and physician practice administrators who discussed their experiences with bundled payments.
Steven Mash, MD, musculoskeletal medical director at DuPage Medical Group, explained, “when you put the data up in an un-blinded way, it moves [doctors]...We’ve also used a predictive analytics program from the beginning. Everyone involved with the patient can see where the patient is along the pathway. We are now managing 4,000 cases a year with one case manager using this technology.”2
“Inclusion and exclusion criteria is especially problematic for spine surgery,” Ellis M. “Mac” Knight, MD, the senior vice president and CMO of the Coker Group said, “Patient selection is probably one of the greatest obstacles to making bundles work in surgical specialties.”3
Workforce issues were also addressed throughout the three-day conference. Richard Wohns, MD, founder, president and neurosurgeon at NeoSpine in Puyallup, Wash., shed light on the disappearance of independent practice. “The driving focus for young residents is finding a job with financial security and job security, which is larger institutions over private practice.”4
When considering the transition from first-generation compensation and alignment contracts to second-generation models, there are several factors to consider, according to panelists Max Reiboldt, president and CEO of Coker Group, and Bashar Naser, CFO of Gerald Champion Regional Medical Center.
“[I]t is important to adjust compensation and alignment models [to evolving reimbursement structures].” For example, one can “ensure an organization’s productivity and revenue goals are being met with some sort of productivity incentive; however, begin tying them with other incentives such as cost savings or quality.”5
When it comes to industry trends and viability, several speakers noted ASC development has increased to meet growing demand, particularly as CMS shifts more procedures to the outpatient setting. Hospitals are entering the ASC market as well, whether as owner/operators or in partnerships. These partnerships enable the ASC to negotiate better contracts and address the desire of health systems to open outpatient centers. For folks who are wish to maintain some autonomy, there are novel examples of affiliation.
A Texas neurosurgeon and ASC medical director reported, “We have a hybrid model [by which] we get to manage ourselves, [but] have a very strong working relationship and contract with... one of the two large healthcare systems in Dallas.”
Contrary to this consolidation trend, many speakers attest to the resiliency of independent practices, and independent physicians are now moving towards forming groups to retain autonomy as well as transform to new compensation, operational and marketing models, according to Marsha Lindsay, chair and chief strategist of growth, brand and innovation at Lindsay, Stone & Briggs.6
All of these models seek and promote ‘value’. Value to the payer, value to the patient, value to the health system at large. “We live in a value-driven society,” said Frank Phillips, MD, the director of the division of spine surgery and orthopedic surgery professor at Rush University Medical Center, and
“Value is all in the eyes of the beholder,” said Frank Phillips, MD, the director of the division of spine surgery and orthopedic surgery professor at Rush University Medical Center. “For insurance companies, ‘value’ is returning value to shareholders. That’s a fact of the economy.”7