"We look at it as a partnership with hospitals because you can't do without hospitals — there are still patients that do not meet criteria to be served or operated on in the ASC world." 

John Russell, director of area operations for seven of Sutter Health's 36 ASCs in Northern California

 "Before your facility's accreditation, look at whether higher compliance with the standards showed an increase in quality of care. You can do a lot of benchmarking with that as well."

Jen Pagel, MSN, RN, quality manager, OAM Surgery Center at MidTowne (Grand Rapids, Mich.)

"In my discussions with payers, when you really peel back the onion — yes, they want cheaper, better, faster — but their goals are really about mitigating risk. They want predictability, especially in spine."

Ronjon Paul, MD, chairman of spine surgery at Duly Health and Care (Downers Grove, Ill.)

Increase in Outpatient Procedures: ASCs are seeing a spike in outpatient procedures, driven by advancements in minimally invasive techniques and a shift toward value-based care. This trend is reducing the need for hospital admissions and promoting patient convenience without compromising quality.

Amid these changes, several leaders in panel discussions underscored the importance of hospital and ASC collaboration. John Russell, director of area operations for seven of Sutter Health's 36 ASCs in Northern California, said he's approaching the trend from the lens of what best serves the patient.

"We look at it as a partnership with hospitals because you can't do without hospitals — there are still patients that do not meet criteria to be served or operated on in the ASC world," Mr. Russell said during a discussion on financial growth opportunities for orthopedics, spine and pain management. "So where we're coming from, some of my centers are not in a place where we have a Sutter hospital, so we've partnered with those local hospitals to make sure the patient is at the right place. So it's a collaboration; it's not hospitals against ASCs. We do need both." 
 

Hospital Partnerships and M&A: The trend toward consolidation and hospital partnerships for ASCs is driven by the need for integrated care, cost efficiencies and enhanced patient outcomes. These partnerships allow ASCs to leverage hospital resources, technology and expertise, providing high-quality surgical care in a more convenient and cost-effective outpatient setting. 

In a discussion on M&A activity, Dr. Yadhati of Ortho Rhode Island described the benefits of mergers he's seen professionally and organizationally. "Because of that process of coming together and being able to create that strength in numbers, we've exploded our outpatient arthroplasty volume," he said. "Spine's next to come online, once we get some of the capital equipment we're hoping to have to support that process as well. So I'm super fortunate that I latched myself on the group back when I was a fellow. The growth story has been tremendous just as part of that merger."

Regulatory and Compliance Challenges: Navigating the complex landscape of healthcare regulations remains a significant concern. Compliance with Medicare's stringent requirements, payer contracts and local healthcare laws is critical, demanding ongoing effort and resources from healthcare providers. Noncompete bans are also affecting ASCs, possibly allowing more surgeons to leave the hospital for ASC ownership. But ASCs may also see an uptick of surgeons and staff exiting for other centers.

In a panel discussion that covered strategies for acing ASC accreditation and strengthening care quality, leaders discussed the critical role of staff satisfaction, as well as benchmarking, to retain ASC staff and ensure compliance standards are met. 

"Transfer rates, infection rates, staff satisfaction — if you're meeting the standards, you're probably doing alright in those areas," LoAnn Vande Leest, RN, interim executive director, The Orthopaedic Surgery Center said. 

Jen Pagel, MSN, RN, quality manager, OAM Surgery Center at MidTowne (Grand Rapids, Mich.) added to Ms. Vande Leest's comments, urging leaders to look at peer sites' performance for comparison and goal setting. 

"Just looking at those indicators of care quality relevant to the accreditation standards and patient outcomes that could be affected by the standards — so infection rates, adherence to the different clinical guidelines, adherence to the facility requirements — and you can benchmark with other sites that have the same accreditation," Ms. Pagel said. "Before your facility's accreditation, look at whether higher compliance with the standards showed an increase in quality of care. You can do a lot of benchmarking with that as well."

Payer Policy Updates: Reimbursement trends for ASCs increasingly favor value-based care models, emphasizing cost efficiency and patient outcomes. Payers, including Medicare and private insurers, are gradually adjusting reimbursement rates to reflect the lower costs and high-quality care provided by ASCs compared to traditional hospital settings. But many ASCs also report more denials, preauthorizations and other barriers to providing efficient care.

Dr. Bruggeman of Texas Spine Care Center noted a specific denial trend he's seeing across orthopedic groups. "In speaking with orthopedic groups across the country on a regular basis, the biggest thing we're hearing is site-of-service denials," he said.

He described how this trend often creates a patient-surgeon "limbo" and general uncertainty about where and how the surgeon will perform the case in a way that won't delay care nor increase the complexity of the denial. 

"It's significantly changing the dynamics of the healthcare systems," Dr. Bruggeman said. At his own practice, Dr. Bruggeman is also seeing partial denials, where payers will deny one of multiple codes submitted for a procedure. 

"So then you're stuck in a quandary — you have a patient who is eligible to get the surgery done, but do you really want to go in and fight and delay this process further to try and get paid for all of the procedures you're going to do? Or do you just kind of bite the bullet and get paid 75% of what you were going to get paid?" he said.
 

Cost Containment and Efficiency: Cost control is increasingly important amid rising healthcare expenditures. Practices are employing lean management techniques, optimizing resource utilization and adopting financial management software to maintain profitability while delivering high-quality care.

Shannon Cameron, COO of AFS, a subsidiary of Harvard Medical Faculty Physicians (Boston), noted her organization's financial strategy has centered on the notion of learning to do more with less.

"One of the things we've done over the past few years, which of course was forced upon us through COVID, is moving to a remote staff [for administrative functions]. That's been an enormous cost savings for our organization," Ms. Cameron said in a panel discussion. "Our lease was up for the billing center last October, so I was able to meet with the architect and we reduced overhead by 50%. So that was a huge cost savings. So we're looking inward, where can we make those changes? We're a teaching organization, so anytime we have a profit in our organization, that goes back into research; it goes back into training and it helps with supplementing the grant money that our organization receives. So we're highly motivated from that perspective, but also there's a continual understanding and culture of transparency in those cost savings."