As healthcare continues its shift toward outpatient care and value-based models, orthopedic surgeons are finding themselves at the intersection of payer dynamics and clinical innovation.
Brett Shore, MD, president and CEO of Shore Orthopedics and an orthopedic surgeon with DISC Sports and Spine Center, shared key insights during a Becker’s Healthcare Podcast recorded live at the 22nd Annual Spine, Orthopedic and Pain Management Conference in June.
Partnerships with payers are transforming care delivery, and have implications on staffing and reimbursement. Dr. Shore’s remarks highlight the ongoing recalibration of healthcare economics and access as outpatient procedures gain ground.
- Payers and surgery centers are forming new alliances
Dr. Shore underscored a growing trend: the formation of strategic partnerships between ASCs and payers.
“One of the things that we see at DISC and that I think is a trend across the industry is the formation of partnerships between some of the surgery centers and the payers, the insurance providers,” he said.
These alliances aim to reduce costs for both patients and insurers while maximizing value across the board. Dr. Shore explained that these models can benefit all stakeholders — patients, providers and payers — by delivering efficient, high-quality care at lower costs. He also emphasized that they offer a mechanism to improve reimbursement for physicians and anesthesiologists, “when done in a way that… improves physician reimbursement both on the surgical and the anesthesia side.”
- Medicare remains a reimbursement wild card
While commercial payer partnerships offer promise, Medicare presents ongoing complications for ASCs. “There are some procedures that are reimbursed reasonably well but others which are not,” Dr. Shore said. “Understanding how to incorporate or choosing not to incorporate Medicare into the ambulatory model is going to be critical for the success of surgery centers going forward.”
He noted that without adjustments to Medicare reimbursement rates, practices and ASCs will continue to face tough decisions.
“There doesn’t seem to be a lot of appetite for increasing the reimbursement rates in Medicare in the federal government anytime soon,” he added.
- Ambulatory shift is accelerating with orthopedic leadership
Orthopedic procedures are increasingly moving to ambulatory surgery centers, thanks in part to advances in minimally invasive techniques and improved perioperative care.
“I think orthopedics lends itself nicely to outpatient care in general,” Dr. Shore said, pointing to his own experience with hip procedures and blood-sparing agents such as tranexamic acid. “I think back to some of the surgeries that were two to three night or more overnight stays when I was in my training… and now a lot of those surgeries [are] either done as 23-hour OBS or same day discharges”.
Orthopedic surgeons are poised to lead the charge in making ambulatory care the norm rather than the exception.
- Anesthesia staffing has become a critical pressure point
Anesthesia staffing is a challenge for almost all surgery centers. Some are employing anesthesiologists or offering them partnership in the ASC. Others are struggling to contract with local groups serving a variety of community organizations.
“The landscape in anesthesia has changed dramatically over the last five to 10 years in terms of both availability and reimbursement,” he said. His perspective is informed by firsthand knowledge — his wife, Amy Shore, MD, is an anesthesiologist and medical director of their surgery center.
Because high-quality anesthesia is critical to ASC performance and safety, Dr. Shore said, “it’s an area where both DISC Sports and Spine and other organizations, I think, are putting a greater emphasis on reimbursement and bringing on well trained qualified anesthesiologists.”
- Value alignment is key to innovation success
Dr. Shore reiterated that payer partnerships work best when they satisfy three criteria: safe and effective care, cost savings for all parties, and improved reimbursement for providers. “When you can check all those boxes, then it ends up being… a really promising development in the ambulatory surgery model,” he said.
He cautioned that successful collaboration requires a careful balance of financial incentives and clinical integrity. The right structure not only sustains the surgery center but also elevates care standards and strengthens the payer-provider relationship.
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