June 16, 2022

Healthcare analytics firm tells medical device companies to adjust their go-to-market strategies.

The Hartford Healthcare HealthCenter
SEISMIC SHIFT As facilities like the 47,000-square-foot Hartford Healthcare HealthCenter come online and procedures continue to flow from hospitals to same-day centers, device manufacturers and payers are increasing their focus on ASCs.

It's not your imagination. More and more procedures continue to move from hospitals to ASCs. A recent whitepaper says that, despite some backtracking from CMS, the trend will continue for years to come.

The whitepaper from Definitive Healthcare, a provider of healthcare commercial intelligence in Framingham, Mass., was written for medical device companies looking to adjust to changing market conditions. It describes "evidence of acceptability for this change in care setting" through three primary indicators.

Positive clinical outcomes. The paper cites a pre-pandemic NIH.gov study that found significant disparities between hospitals and ASCs, particularly in terms of 30- and 90-day readmission rates and post-surgical complications for inpatient and outpatient procedures. It found that ASCs have drastically lower readmission and post-surgical complication rates. Once the pandemic arrived, the paper says even more elective and non-essential procedures were shifted safely from COVID-focused hospitals to ASCs.

As further evidence about positive outcomes at ASCs, the whitepaper cites a 2021 retroactive study focusing on Medicare outpatient outcomes for patients who underwent primary total knee arthroplasty (TKA) that found that only 5.5% of them experienced complications in ASCs. "Both Medicare and privately insured patients are seeing positive clinical outcomes in the ASC setting contributing strongly to a shift in care," the paper states. "The positive clinical outcomes have additional implications on insurance pay-outs and CMS reimbursements."

Overall economic savings. The whitepaper describes the cost difference between hospitals and ASCs as "noticeable and significantly in favor of ASCs," and estimates an overall reduction in healthcare costs of more than $38 billion annually simply due to the availability of ASCs. It states that while some procedures that involve multiday inpatient recoveries will not migrate to ASCs as long as the 24-hour stay rule is in place, any other procedure deemed safe and acceptable in the same-day setting should shift to ASCs due to significant cost savings. It also notes that more than $5 billion of the $38 billion in reduced costs is passed on to the patient through lower deductibles and co-pays.

The whitepaper also notes that HOPD prices for the same procedure in all markets are significantly higher than ASC prices, regardless of the payer. "For example, according to CMS' procedure price lookup tool, the agency pays ASCs $3,134 to repair a shoulder rotator cuff using an endoscope and HOPDs $5,677 for the same procedure," it says. "Furthermore, for the same procedure, ASCs are typically reimbursed at 53% of the rate being reimbursed to HOPDs. These values and differences add up to an overwhelming cost savings at the national level."

The firm believes that despite CMS' backtracking on the elimination of the inpatient-only list, hospital-required procedures will continue to be under scrutiny. CPT codes for lumbar spine fusion as well as shoulder and ankle joint reconstruction, along with their corresponding anesthesia codes, remain approved for performing in ASC settings, it adds, indicating that CMS will likely continue to shift previously inpatient procedures to ASCs.

Market acquisition and growth activity. Because large health systems are losing business to ASCs, they're choosing to buy into the ASC space through targeted acquisitions. As examples, the whitepaper cites UnitedHealth/Optum's 2017 acquisition of Surgical Care Affiliates for $2.3 billion, and its current ownership of 200 ASCs across 33 states. It also points to Tenet Healthcare subsidiary United Surgical Partners International's recent $1.2 billion acquisition of SurgCenter Development, which gave it ownership interests in 92 ASCs. "Potential earnings in this space appear to be on the rise, making this market prime for more merger and acquisition deals like these," the whitepaper says.

The whitepaper notes that the COVID-19 pandemic has only accelerated the shift. "The volume of outpatient surgical procedures performed in a hospital setting was already trending downward prior to the pandemic," says Definitive Healthcare, citing its own data that between 2019 and 2020, such procedures decreased at hospitals by more than 15%. "How do we know that this shift in care is not solely driven by the COVID-19 pandemic?" notes the whitepaper. "By comparing claims volume for procedures performed in hospitals versus ASCs in 2020 and 2021, we see there is a clear year-over-year increase in ASC procedure volume."

Definitive Healthcare's data insights from 2021 found that the monthly average increase of ASC claims was 47.1% compared to 2020. "This intelligence informs us that even though many hospitals have resumed their elective procedures, ASC procedure volumes continue to increase as a potentially preferred venue," the whitepaper states. "Based on the additional evidence outside of 2021 claims intelligence, it is anticipated that this shift in care will continue to increase post-pandemic."

Growth is only possible with an efficient instrument reprocessing system.

Darci Nagorski
BIG CLEAN St. Cloud Surgical Center tripled the size of its sterile processing department to 3,739 square feet to keep up with its patient volume and instrument demand.

If you can't reprocess your instruments as quickly and efficiently as your case mix dictates, it doesn't matter how much demand there is for increased volume at your facility, as your growth projections will never come to fruition. An efficient sterile processing department (SPD) is a critical component of any high-volume facility, and surgical leaders should make it a priority during expansion projects.

St. Cloud (Minn.) Surgical Center, for example, focused first on its SPD when it recently renovated the 35-year-old facility. "We physically did not have the capacity to get the instrument throughput we needed," says Darci Nagorski, St. Cloud's administrator and CEO. "We had to add another washer and another sterilizer, but didn't have the workspace to get the job done."

St. Cloud's solution was to move its SPD to a different area of its facility and nearly tripled its size to 3,739 square feet. It then overhauled the makeup of the SPD by adding new washers, sterilizers and ergonomic workstations, which Ms. Nagorski says the SPD staff desperately needed. The original SPD, meanwhile, was converted to two 650-square-foot operating rooms, which are significantly larger than the other 430-square-foot ORs in the facility.

When all was said and done, the facility performed nearly 1,000 total joint cases in 2021, more than doubling the nearly 400 procedures it performed in 2020. Ms. Nagorski says a big part of that growth was due to the new and improved instrument reprocessing space. "We needed a better workflow for our team, and we achieved that with all the updates to our SPD," she says.

Directors and managers in ambulatory surgery facilities reveal their preferences to help them introduce new procedures, manage best practices and evolve their business.

BD

The activity in the ambulatory surgery environment continues to heat up as OR leaders anticipate more surgeries in 2022, according to a recent survey conducted by Outpatient Surgery Magazine on behalf of BD. With the backdrop of the past two years with the COVID-19 pandemic – and amidst the challenging staffing, supply chain and patient care issues surrounding this world-wide healthcare crisis – healthcare professionals are gearing up for a busy time this year at their facilities.

More than 60% of the survey respondents said that they expect to see an increase in surgical procedures in 2022, and more than 25% anticipated that the 2021 levels would be matched. The sub-specialties that were mentioned for growth include orthopedics, neuro/spine, ophthalmology, gastroenterology and ENT, with orthopedic procedures receiving the highest increase. This is not surprising as total joints continues to play a strong role in the surgeries moving from inpatient to outpatient during the past two years.

As more procedures are introduced into a facility, the administrative and clinical staffs will take a closer look at existing equipment, current protocols and even the footprint of their existing facility to see where improvements should be made. They will turn to partners from industry who work closely with them to offer strategies and guidance as well as new solutions and products to help move the needle as both micro and macro improvements are sought.

Choosing the best partner to make significant changes to the status quo is an important decision as OR leaders investigate their options. One of the largest global medical technology companies in the world, BD is advancing the world of health^™ by improving medical discovery, diagnostics and the delivery of care and developing innovative technology, services and solutions that help advance both clinical therapy for patients and clinical process for healthcare providers.

By working in close collaboration with customers, BD can help enhance outcomes, lower costs, increase efficiencies, improve safety and expand access to healthcare. Additionally, BD offers a comprehensive portfolio of products and services that focuses exclusively on the ASC market. Offering deep ASC experience, the company's ASC team provides a combination of technology, products and support to help manage new procedures and enhance existing business.

In the survey sponsored by BD, Outpatient Surgery Magazine investigated the relationship between partners and ambulatory decision-makers. The focus was on how these decision-makers prefer to interact with partners to conduct business and move their business forward. One-third of the survey respondents preferred face-to-face meetings to conduct business interactions.

Most important, the survey respondents also indicated a strong desire to receive in-person training and support from their partners — more than 80% desired that outcome for 2022 as growth in ASCs accelerates. Furthermore, on-site education was top on the list with close to 70% expressing the need for staff education from their partners and more than 40% said they would be satisfied with virtual education offerings as well.

The BD Ambulatory Surgery Center portfolio of category-leading products, innovative solutions and dedicated support is designed to help ASCs improve clinical efficiency and enhance patient care. In this fast-pace ambulatory market, education, training and customized support will go a long way to help individual ASCs secure a strong foothold in their communities and offer quality patient care.

Note: For more information please go to BD Ambulatory Surgery Centers — Products & Solutions and BD Quality Solutions Brochure 2020.pdf

Note: For a Whitepaper on the survey sponsored by BD please go to BD Whitepaper - Outpatient Surgery Magazine (aorn.org)