Accelerated Growth Spurs Innovation and Change

By: Outpatient Surgery Editors

Published: 6/28/2021

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The COVID-19 pandemic has pushed ambulatory facilities to the brink and back, with more momentum than the community has experienced in the last decade.


Innovation starts with change. And change comes in many different forms – perhaps it's a natural progression as industries and professions evolve or, conversely, it could be a sudden event or series of events that accelerates change. The COVID-19 pandemic is one such accelerator for the ambulatory surgery community. Clearly, the pandemic has turned the ambulatory community on its' collective head.

OR leaders coped with shut-downs and lack of equipment and protocols for an unknown disease, experienced major staffing challenges, and then, had to deal with the return to surgery. Add to the picture the fact that the outpatient surgery evolution was already underway as new procedures migrated to the outpatient setting and you've got a robust recipe for change and, in fact, rapid change.

"2020 was a unique year for the healthcare industry as it experienced a once in a lifetime event."

According a recent blog by VMG Health's "ASCs in 2020: A Year in Review" by Colin Park, CPA/ABV, ASA, the path in 2020 was all about disruptive change: "2020 was a unique year for the healthcare industry as it experienced a once in a lifetime event. While the healthcare market as a whole was tremendously impacted by the coronavirus ("COVID-19") pandemic, the Ambulatory Surgery Center ("ASC") sub-industry was acutely impacted due to interruptions in normal operations caused by the pandemic."

"2020 was a unique year for the healthcare industry as it experienced a once in a lifetime event.”

He further notes, "Along with a major, multi-site, transaction in the ASC market in 2020, the fragmented ASC industry continued to consolidate. For ASC's, we have continued to see the continuation of certain trends from 2019 through 2020: the shift of higher acuity procedures from the inpatient setting to the outpatient setting, increased Medicare reimbursement rates, consolidation, and increased activity by hospitals seeking to grow their ambulatory footprint with a particular focus on ASCs."

CMS released the addition of 11 procedures to the ASC covered procedures list (CPL) on December 2, 2020 – most notably including total hip arthroplasty (hip replacement surgery). Additionally, CMS revised the criteria used to add covered surgical procedures to the ASC CPL and under the revised criteria, CMS is adding an additional 267 surgical procedures to the ASC CPL beginning in 2021.

As more procedures migrate to ASCs, it is important to pay close attention to what these are and, in fact, how they will impact future capital expenditures and staff training. As facilities incorporate new procedures there will be a compelling need to reset, refresh and renew their individual goals and overall missions. How the leadership goes about doing this is personal and depends on many factors, but it is clear that changes will continue to spur innovation across the field.

Where is the growth happening?

One area of growth impacting ambulatory settings are complex spine procedures, which are moving forward to focus specifically on the minimally invasive spine procedures that are supported by new products and procedures. Previously, ASCs performed spinal fusion and disc decompression already for years, but new are the single- and two-level 360-degree fusions. Single specialty and multi-specialty ASCs will refocus their game plan for outpatient spine patients as this area is expected to evolve in the coming years.

Also new on the horizon are cardiology procedures which are expanding into the outpatient arena, often in single-special ASCs. This evolution with continue as Medicare approved the coronary atherectomy and percutaneous coronary intervention surgeries. Depending on the state, cardiac procedures including angioplasties, catheterizations, pacemaker insertion and loop recorder placement, will be allowed as facilities expand their offerings to accommodate the boomer population which will be undoubtedly impacted.

Total joints are also a big part of the picture. This surgery has already been on the scene – and it is moving quickly as volume intensifies and patients are released sooner with post-operative care. Today, Medicare covers total knee, allowed in 2020, and total hip replacements, allowed in 2021. Other total joint procedures successfully performed in the ASC environment include total shoulder, ankle and elbow arthroplasty. Across the country, volume is expected to increase for total joints in outpatient facilities. Service lines are expanding, OR rooms are being created, and more physicians are being recruited for this growth area.

Technology will continue to drive innovation…

Watching the trends

TOTAL JOINTS The upsurge of total joints surgeries is just one of the growth areas in ambulatory surgery.

Technology will continue to drive innovation, and the ASC surgical suite may have a different look in the future as robotic systems potentially are incorporated into these facilities. However, the ongoing debate about cost and ROI will also continue.

The most common procedures that will embrace robotics are total joint replacements. While the cost may be prohibitive for some facilities, others are looking to the future as they decide to incorporate robotic technologies. By investing now, these facilities may be better positioned to recruit newly trained surgeons who will have the expectation to work with these systems as total joints programs grow in volume and efficiency.

Additional technology innovations are taking place that directly impact the patient experience – and outpatient surgery leaders are taking note. Patient engagement tools are a key investment that took a front-row seat during the pandemic as patients expected better ways to safely communicate and coordinate their care.

Centers that nimbly focused on the on-line patient experience and streamlined their systems for both pre-operative and post-operative care positioned themselves for success. Enhanced communication tools such as health tracking tools and better notification and form-filling systems contribute to the positive, high-tech virtual experience that patients have come to expect in every part of their lives.

The "people factor" is another important indicator of what the future holds for the outpatient surgery community. As the pandemic progressed, with all the regional ups and downs, OR leaders paid close attention to their staffs and the well-being of the people who make each facility function. In many industries impacted by the pandemic, burnout and fatigue hit hard but healthcare professionals were particularly hard hit.

For this group, remote work was not an option and the rising caseloads, lack of supplies, uncertainty of surgeries, and the intense focus on new infection prevention strategies all contributed heavily to what is going to be an ongoing crisis within the healthcare profession. This crisis will impact surgeons, OR leaders and administrators and nurses alike, based on indications seen in surveys by professional organizations, town halls, online information and reporting. What exactly is impacting the "people factor" so much more today than in the past? That crisis will be a critical shortage of trained staff who can take on the new challenges, especially in the ASCs who hope to provide new procedures to evolve their business. Retaining talent also will become an even higher priority as OR leaders look to shore up the critical teams on which future growth depends.

Companies who adapt to the new market, and quickly offer solutions at a price point ASCs can handle, will be successful.

Companies who adapt to the new market, and quickly offer solutions at a price point ASCs can handle, will be successful.

Industry is watching, too

TARGETED APPROACH Minimizing muscle and tissue damage helps to limit post-op pain.

The laser focus on the changing world of outpatient surgery impacts all players in the space. That includes industry, too, which offers innovation and new technology to follow the trends. Analysts have reported that medical device companies should pay close attention to the movements in the ASC market and all the implications for innovation. According to Bain & Company, "The rise of ambulatory surgery centers (ASCs) is creating challenges for medtech companies. Analysts predict ASCs will carry out 27 million procedures in 2021, up from 20 million in 2015, with particularly fast growth forecast in the orthopaedic, spine and cardiology markets."

In fact, some companies already have shifted focus to the ASC market to take advantage of the evolution in progress. According to Bain & Company, "The need for medtech companies to take ASCs, which perform surgeries that do not require an overnight stay, seriously is evident in the data. In 2017, ASCs performed more than half of total U.S. outpatient procedures, as compared to less than one-third in 2005. In cardiology, for instance, Bain thinks ASCs' share of the cardiology market will rise from 4% in 2015 to 33% in the mid-2020s."

Companies who adapt to the new market, and quickly offer solutions at a price point ASCs can handle, will be successful. ASCs traditionally have smaller budgets than hospitals for improvements, so attention needs to be paid to that aspect of the current situation.

According to Bain analysts, "Companies can capture the ASC market by implementing virtual operating room representatives, outsourcing logistics and otherwise lowering their costs." They also argue that companies should consider simplifying their portfolios and creating procedure-in-a-box kits. Through these changes, companies may be able to offer the 15% discount that would persuade most ASCs to switch to a different device.

The impact of the COVID-19 pandemic is still being felt today — and it will be felt for years to come as all healthcare sectors reboot. Recovery needs to include innovative thinking, data analysis of future healthcare needs and market trends, developing and embracing new technologies — and, perhaps most importantly, nurturing a resilient and highly trained workforce that will form the backbone of any successful facility. OSM