Image by Tung Nguyen from PixabayAs ambulatory surgery centers (ASCs) face challenges like supply-chain disruptions and payer negotiations, strategic partnerships are becoming more necessary for long-term success.
From collaborating with hospital systems to leveraging industry innovations and payer savings programs, ASC leaders shared their thoughts on building relationships that drive efficiency and improve patient care during a recent panel discussion at an industry conference.
“For us, our valuable partners are the health system,” Caitlin Colangelo, administrator of the Orlando Health Jewett Orthopedic Institute Surgery Center, said during the panel. “Having that backing of Orlando Health has been extremely helpful in navigating the supply-chain shortages and our payer reimbursements, helping us develop implant carve-outs.”
The Orlando Health Jewett Orthopedic Institute Surgery Center is a Florida-based ASC with 12 operating rooms and three minor procedure rooms, for orthopedic and spine surgeries.
Colangelo said her team meets quarterly to review volumes and figure out which cases are best suited for the ASC for reimbursement purposes, and what makes sense cost-wise to do in the ambulatory surgery center versus the hospital.
Finding ways to make hospital systems and outpatient facilities work toward the same goals is also vital, Andrew Lovewell, CEO of Columbia Orthopaedic Group, said at the event.
Missouri-based Columbia Orthopaedic Group works with around 25 physicians under one roof to perform spinal and orthopedic procedures.
“Do the physicians and the health system or hospital have aligned incentives? Are we working together toward a common goal? Are we working against each other?” he said.
There can be challenges transitioning care when hospitals don’t recognize the value of ASC partnerships, Lovewell said. His team offered their hospital partner an opportunity to buy equity in their ASC, but the hospital leadership initially declined, failing to see the long-term benefits, he said.
“We recognize the value [the hospital system] brings to the table,” he said. “They employ 100 primary care docs that refer us to patients. We’re very comfortable having fully aligned incentives with the hospital to work with. It’s just that their leadership at the time did not see the value.”
Partnerships beyond the hospital
Unconventional partnerships can also drive ASC success, panelists said.
Industry collaborations, such as leveraging high-volume purchases of disposables to reduce costs on equipment like arthroscopy towers, have been helpful to his operation, Michael Redler, orthopedic surgeon with Connecticut Orthopedics, said during the panel.
“If you’re using a lot of disposables for one company, your things for arthroscopy, that will go toward the price of the towers, and so you can get some cost savings there,” he said.
He also encouraged ASCs to think outside the box, particularly regarding anesthesia and staff.
“What makes a tremendously successful surgical center is the quality of anesthesia, the ability to perform regional blocks, ensuring patients are comfortable, and being able to do blocks in the block room without taking up operating room time,” he said. “Having an anesthesia care model where there are CRNAs as well is key. If you have comfortable patients and terrific regional anesthesia, you’re going to have happy patients.”
The use of Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia in ambulatory surgery centers varies from state to state, with some states requiring CRNAs to be supervised by a physician or an anesthesiologist, while others allow independent practice.
Industry collaborations and surgery savings programs
Surgery savings programs with major payers allow his ASC to share in the savings when cases are moved from high-acuity to lower-acuity settings, Lovewell said, adding that his center has seen success in leveraging partnerships with payers and industry to drive efficiency.
“We have surgery savings programs with a couple of the large payers,” he said. “So any case that we take from a higher-acuity setting to a lower-acuity setting, we get a portion of the savings that are attributable there. Lucky for us, one of the payers wanted to sign that contract right as we were doing our expansion, … so we considered that to kind of just be found money at that point.”
Strong industry collaborations, particularly in his organization’s spine division, have enabled the adoption of innovative technologies through research foundations, Lovewell said.
“So we can do local knee arthroscopy with a nanoscope to make sure our teams and our staff are, you know, well-suited for that,” he said. “It also helps with our anesthesia problem, because we can’t always find the issues of staff-to-staff and OR, so we’ll still do cases with their technology and kind of keep our surgeons going. So there’s no dissatisfaction there as well.”
