Looking ahead, 2025 may be the year of the outpatient orthopedic surgery center.
That’s according to Jon Van Valkenburg, executive director of Upstate Orthopedics Ambulatory Surgery Center (ASC) in East Syracuse, New York, who spoke to the Ambulatory Surgery Center Association (ASCA) for their podcast.
In 2024, the U.S. Centers for Medicare & Medicaid Services (CMS) added total shoulder arthroplasties to its approved procedures list for ASCs. That, in turn, created opportunities for growth.
“That’s been a great addition for surgery centers because a total shoulder arthroplasty is an upper extremity surgery, and it’s very naturally ambulatory,” Van Valkenburg said. “It does not affect their ability to walk or the ability to discharge them.”
He also pointed to the growing use of robotics in total joint procedures.
“We’ve started to see robotics in ASCs because some of those manufacturers and vendors that have this technology have recognized that the migration is happening,” he said.
Still, there are financial challenges posed by new technologies such as robotics and advanced imaging systems. While these innovations offer significant benefits for patients, they come with a steep price tag.
“It only works in high-volume situations,” Van Valkenburg said.
Furthermore, spine procedures are increasingly moving to ASCs, with multi-level surgeries now being performed.
“We’re starting to see two- and three-level ACDFs (anterior cervical discectomy and fusion) in the ambulatory surgery space,” Van Valkenburg said, citing improvements in outcomes as a driver of the trend.
Minimally invasive foot surgeries, such as bunion procedures, are another area of growth for ASCs, he added.
“We’ve seen some new products and some new technology out on the market that has allowed for those procedures to be performed with smaller incisions, and we see that as more opportunity for growth in that space,” he said.
Despite these and other tailwinds for orthopedic ASCs, challenges lie ahead, too.
“We’ve seen the amount we have to pay to recruit and retain nurses and other clinical staff [rise], especially in a very highly competitive labor market,” he said. “The need to increase compensation has placed additional pressure on ASCs, which typically operate on tighter margins.”
Another pressing challenge is the shortage of anesthesia providers.
Both anesthesiologists and certified registered nurse anesthetists (CRNAs) are in high demand, and as a result, ASCs are having to offer financial incentives to secure their services.
“ASCs are having to start to pay a stipend, pay some type of subsidy to these anesthesia providers just to keep their OR staffed,” he said, adding that this is an expense that ASCs hadn’t previously needed to factor into their budgets.
This, combined with the already tight reimbursement structure for ASCs, has made it increasingly difficult for some centers to maintain financial viability.
The growing financial pressures could lead to reduced patient access to certain procedures, particularly lower-margin surgeries, Van Valkenburg said.
“ASCs, particularly in orthopedics, are starting to skew toward where the margins are still good, and access for those other procedures that haven’t been done in hospitals in years is decreasing,” he said.
There have been some positive developments in recruitment and retention, however. After a difficult post-COVID labor market, where hospitals were able to lure staff away with higher pay, ASCs are now seeing many clinical staff return.
Many staff members who left for higher-paying hospital jobs are now coming back to ASCs due to the better work-life balance they offer.
“We’ve seen the pendulum kind of swing back in the other direction now, where it’s becoming more of a quality-of-life thing for those staff,” Van Valkenburg said.
