Podiatry’s Role in Ambulatory Surgical Centers

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One of my favorite conferences to participate in is the Notre Dame Orthopedic Society Symposium. The conference is a tremendous event. I have been fortunate enough to speak at it for the past 3 years—the past 2 years as the only podiatric speaker.
 
During the general session before the specialty breakout sessions, one of my favorite presentations every year is on the future of orthopedics. Different speakers from different backgrounds give this talk every year. This year, it was Anthony A. Romeo, MD, an orthopedic surgeon. The presentation was fabulous and yet daunting at the same time. The take-home message was that healthcare is changing, and orthopedics must be at the forefront of the change and be an active collaborator.

"Physician partnership is a fulcrum for market power."
—A. Romeo, MD

The shift towards the value-based healthcare model aims to create an ecosystem with the "potential to deliver a personalized and integrated experience to consumers, enhance provider productivity, engage formal and informal caregivers, and improve outcomes and affordability."¹ Where does podiatry fit into this model, and how can podiatric physicians optimize the opportunity?
 
The Center for Medicare and Medicaid Innovation (CMMI) recognizes podiatry's role in the evolving healthcare model by granting Upperline Health the first specialty Accountable Care Organization (ACO) REACH contract.² Upperline's approach to an ecosystem that brings comprehensive and coordinated care to treat chronic disease patients disrupts healthcare and drives change.
 
Another trend in orthopedics that provides an opportunity for podiatric physicians is the shift in orthopedic surgeries to ambulatory surgery centers (ASCs). As Dr. Romero noted, "One ancillary service critical to the long-term sustainability and success of an orthopedic practice is ASC ownership and management. ASCs are valuable assets when surgeons establish an efficient, low-overhead, high-volume, patient-focused practice to bring a return on investment (ROI) that incentivizes the best care at the lowest cost and provides margins that support sustainability and growth."³ The change in the site is the move of orthopedic surgeries from hospitals to ASC so much so that now 70% of all orthopedic surgery is performed in ASCs now.⁴
 
Podiatric physicians, like orthopedic surgeons, must own the site of their surgical care, to provide an ancillary source of income for the podiatric surgeon and to improve patient outcomes and satisfaction. Retaining the ability to own the site of surgical care must be part of any contract negotiation to optimize ancillary income. Owning the site of surgical care aligns with the stakeholder's vision of value-based care. "A growing number of commercial insurers are revamping policies to push providers and patients out of the hospital and into ASCs, where procedures can be performed at a lower cost."⁴
 
The stressor of declining fee-for-service reimbursement is real for providers in all employment models. The opportunity in risk-shared value-based care is significant. Successful value-based care must include reducing the per capita cost of care, improving the population's health, and enhancing patient outcomes and experiences. Orthopedic surgical episode spending will always be part of the entire continuum of care. Increased ASC utilization appears to be part of the solution, resulting in a significant opportunity for podiatric physicians.
 
Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, a Fellow of the American College of Foot and Ankle Pediatrics, a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery.

Dr. DeHeer is a Partner with Upperline Health and the Medical Director of Upperline Health Indiana. Dr. DeHeer discloses that he is a speaker for Paragon 28, and that he owns stock in and is employed by Upperline Health.
 
References
1.    Singhal S, Kayyali B, Levin R, Greenberg Z. The next wave of healthcare innovation: The evolution of ecosystems. McKinsey and Company. Published June 23, 2020.
2.    Upperline Health raises $58.35 million to fuel specialty value-based care, building on 300% YOY growth. Business Wire. Published June 7, 2023.
3.    Romeo A. Prioritize the opportunity for ownership of an ASC. Healio. Published Feb. 16, 2023.
4.    Condon A. Commercial payers driving cases to ASCs; orthopedics most primed for growth. Becker’s ASC Review. Published Feb. 7, 2022.

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of Podiatry Today or HMP Global, their employees and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, anyone or anything.