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New CMS Rules Represent Tremendous Opportunity for ASCs

Posted by Debra Zalvan on Mar 9, 2021 6:04:35 PM
Debra Zalvan
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In 2021, the U.S. Centers for Medicare & Medicaid Services (CMS) authorized payment to ambulatory surgery centers (ASCs) for outpatient hip replacement surgeries, adding to the outpatient knee replacement surgeries authorized the previous year. 

The size and projected market growth for outpatient total knee and hip replacement surgeries represent tremendous opportunity—with a projected $13.5B in total joint replacement (TJR) business for ASCs, and nearly half of all joint replacement surgeries expected to move to outpatient centers by 2026.

But while the market and opportunity for ASCs is enormous, so are the challenges, as:

  • Competition from other ASCs, Hospital Outpatient Departments (HOPDs) and joint ventures floods the market 
  • CMS exerts significant downward pressure on payments and margins, setting new benchmarks for what commercial insurers and patients also will be willing to pay for outpatient hip and knee replacement surgeries 
  • Talent wars erupt for qualified surgeons
  • ASCs increasingly assume risk related to performance and outcomes that threaten narrow margins and profitability 

Success in this expanding TJR outpatient marketplace requires you to: 

  • Ensure that the correct systems are in place to guarantee exceptional health outcomes and generate consistently high patient satisfaction scores 
  • Reassure surgeons and payers that your ASC is properly focused on the complete continuum of care – not just the procedure – so that they’re confident in aligning and working with you 
  • Streamline operations to control or reduce both costs and risk across the continuum of care, while supporting the volumes of procedures necessary to operate profitably 

How does an ASC manage these challenges, while also keeping costs under control? 

A powerful tool and essential addition to your patient-centered digital ecosystem and virtual care infrastructure is a patient engagement platform.

An effective virtual patient engagement strategy has many benefits, including:

  • Better prequalification and more effective communication with patients throughout the continuum of care, and in their daily lives
  • Higher levels of compliance and better healthcare outcomes
  • Lower readmission rates and reduced use of Emergency Departments
  • More efficient and less resource-intensive operations
  • Reduced risk associated with performance and outcomes
  • Stronger connections between patients and their healthcare provider
  • Improved patient satisfaction
UbiCare’s SmarteXp® patient engagement platform, combined with our robust Total Joint Replacement content, supports an integrated patient engagement strategy for ASCs that perform hip and knee replacement surgeries. To fully understand the value that UbiCare and SmarteXp® can bring to your organization, schedule a demo. Simply submit the form below. We’ll schedule a short call to learn a little more about your organization and situation, and then customize the demo to make the best use of your valuable time.

Topics: CMS, joint replacement, ASC