Dr. Daniel Lamar As a higher volume of orthopedic procedures shifts into outpatient settings, Coastal Orthopedics is refining its approach to meet the growing demand.
That means continuing to accommodate lower-acuity procedures that the center was built on while expanding access to more complex ones.
Coastal has had a lot of success executing on that vision, too. The Bradenton, Florida-based ambulatory surgery center (ASC) recently earned national recognition as one of the best ASCs in the country by U.S. News & World Report.
Ambulatory Surgery Center News connected with Dr. Daniel Lamar, an orthopedic surgeon and physician president of the surgery center, about the strategies behind Coastal’s success. Lamar also weighed in on technology adoption, patient selection, CMS code changes and what’s ahead for orthopedic care in the ASC setting.
This interview has been edited for length and clarity.
ASC News: Just to start, can you share your thoughts on being recognized as one of the best ASCs in the U.S., and how you think you and your team got there?
Dr. Lamar: Yeah, absolutely. I think it’s always an honor to be recognized for something you’ve put so much effort into. Building this ASC was a major project. It took a lot of resources, energy and time. So we’re really proud of it.
I think what got us here is the way we approached the entire business. We looked at it from the patient’s perspective from the very beginning. That started with how we designed the facility, making sure it was laid out in a way that made sense and felt comfortable throughout the patient journey.
We created a warm, welcoming reception area, space for families to wait, and really tried to make the whole experience smooth and accommodating. Our thinking was that if we delivered an exceptional experience, patient demand would follow. That was the foundation of our approach, and I think it’s why we’ve been successful.
How has the demand for outpatient procedures changed, and where do you see it going?
It’s definitely exploded over the last few years. Several factors have driven that. One has been the long-term shift toward more cost-effective care – moving cases from higher-cost hospital settings into ASCs. That trend had already been underway for years. But then COVID hit, and that really accelerated everything. People wanted to avoid inpatient experiences when possible, and that gave a strong push to outpatient care.
At the same time, we were working on protocols for more complex procedures, like total joint replacements, to be done safely in the outpatient setting. That success has really opened the door to doing almost every orthopedic procedure in an ASC, as long as the patient is appropriate.
We’re always careful to consider health factors and make sure patients can safely go home and have the right support system. But overall, the demand has surged because ASCs offer a more cost-effective way to deliver complex procedures.
Are there any procedures or patient types that you think are especially well-suited for ASCs?
Honestly, for orthopedic surgeons, almost everything we do fits well in an ASC now. A big part of that is because we’re usually working on the extremities, which allows us to use regional anesthesia – what we call peripheral blocks. That means less anesthesia overall and better post-op pain control at home.
As long as patients meet the right criteria, most procedures are a great fit. It really comes down to health status more than age. We don’t have strict age cutoffs. We look at overall wellness, cardiovascular fitness, and whether they can be safely anesthetized, especially if general anesthesia or intubation is needed. Patient selection has always been key to success, especially as we’ve moved into more complex procedures in the outpatient space.
Are there any specific orthopedic or spine procedure codes you think CMS might approve for ASC use in the next few years?
That’s a good question. I know one big recent development was the total shoulder code getting approved for outpatient. It was a big step forward. Beyond that, I think spine codes are becoming more eligible, but I’ll admit I’m probably not the best person to speak to the specifics.
Switching gears a bit, what’s your approach to adopting new surgical technology? Are you using robotics?
Yes, we are. We’re pretty proactive about adopting new technology when we believe it benefits patients. Our approach is simple: If a surgeon believes a technology improves how we deliver care, we take a serious look at it.
We evaluate things from multiple angles, what equipment is required, how it affects workflow, and the business side, like cost. Robotics can be expensive, so that’s a consideration. But we’ve had up to four different robots at our facility at one point. The MAKO robot has found a good home with us, and we’ve had a lot of success with it. In 2024, I believe we performed about 1,700 outpatient total joint procedures, with no significant complications that would make us reconsider this direction.
Would you say your case volume is focused more on lower-acuity procedures or higher-acuity ones?
I’d say our focus is more on the higher-acuity side. The lower-acuity procedures have always been part of the ASC world, but what we’ve done is take on more of the complex cases, ones that need more consideration and patient screening. As CMS has approved more of these procedures for outpatient settings, we’ve evaluated each one carefully and moved forward when it made sense.
Have you had to cut back on lower-acuity cases to make room?
No, not really. As orthopedic surgeons, we can accommodate a pretty large volume. In the past, we did a lot of those higher-acuity cases in hospitals, but now we’re doing many of them in the ASC. Personally, I spend a lot more of my surgical time here than splitting it between the hospital and ASC. We designed this facility with capacity in mind, and we planned for growth. So far, we haven’t had to displace any of the lower-acuity cases to make room.
Are there any other trends you expect to influence orthopedic care in ASCs over the next few years?
Honestly, I think we’ll just see more of the same. Everyone’s working to be more efficient and bring increasingly complex cases into the outpatient space safely. Anesthesia plays a huge role, how we manage patients before, during, and after surgery.
Robotics will likely expand beyond joint replacements. Right now, they’re mostly used for hips and knees, but I can see a future where robotics help guide decisions for more soft tissue procedures too.
Anything else you’d like to add?
Just that we feel really fortunate to have a strong management team at Coastal. We lean heavily on our C-suite and operations leadership to help us succeed. We’re just the ones in the trenches, but they’re the ones helping us navigate all the other challenges, and we couldn’t do it without them.
