January 31, 2024 | The dissemination of bioelectronic medicine therapies is based, to a large extent, on ambulatory surgery centers that perform a majority of minimally invasive surgeries, including medical device implantation and replacement. Implantation procedures performed at ASCs are typically less expensive than those performed at hospitals.
As one example, surgery for implanting SNS devices made by Medtronic or Axonics (CPT codes 64581 for the SNS lead and 64590 for the IPG) for treatment of OAB costs $25,854 when performed at a hospital outpatient clinic vs $20,384 (27% lower) at an ASC, with these estimates taken from online Medicare calculator. As another example, surgery for implanting a subcutaneous posterior tibial nerve stimulation device made by Valencia Technologies (temporary codes 5464 for hospital and 0816T for ASC) for treatment of OAB will cost $20,865 at a hospital outpatient clinic vs $14,130 (32% lower) at an ASC, when these codes go into effect on January 1, 2024.
In addition to their main job of performing surgeries, the ASC operation also involves many non-clinical “back-office” tasks, such as human resources, administrative, accounting, IT, record-keeping, patient scheduling, claims management, risk mitigation, regulatory compliance, marketing, and others. These tasks are rather burdensome for individual ASCs, so many of them are teaming up into a management services organization.
ASCs are presently undergoing a wave of MSO expansion, with MSO-connected clinics providing 5% of total healthcare in 2022 and expected to provide 9% in 2025, according to a report from McKinsey. As more ASCs join, the cost of running an MSO is reduced through economies of scale. Another benefit of an MSO network is in its brand name, allowing easier brand recognition by patients. However, a recent study indicated that once a clinical practice joins an MSO, it tends to increase its claim fees for patients and health insurers.
An important potential benefit of MSOs for the nascent field of bioelectronic medicine lies in their ability to expedite and streamline access of ASC surgeons to the latest neuromodulation technologies, as soon as they enter the market and gain CMS coverage. In parallel, the marketing arm of MSOs can educate patients about these technologies once they become available at participating ASCs.
Another potential benefit of MSOs relates to their supervision of patient care, including implementation of best practices in care, so bioelectronic medicine could be readily added to the list of these best practices. According to Lawrence Kosinski, an expert on gastrointestinal ASCs, a continuum of care for patients with inflammatory bowel disease includes their initial treatment at ASCs specializing in minimally invasive endoscopic treatment of intestinal ulcers. These patients will later transition (as their condition deteriorates over time) to hospitals or larger ASCs for major intestinal surgeries, such as treatment of intestinal fistulae, abscesses, strictures, or obstructions.
With MSOs guiding participating ASCs on best practices in patient care, IBD patients could be advised about a possibility of minimally invasive implantation of an SNS or VNS device, once they gain CMS coverage.
Similarly, patients with rheumatoid arthritis experience progressive deterioration of affected joints and, ultimately, require surgical replacement of hips and knees. These patients can be advised about best practices, including a possibility of minimally-invasive implantation of a VNS device from SetPoint Medical or Galvani Bioelectronics, once these therapies also gain CMS coverage.
It is important to keep in mind that the MSO is an evolving economic model of running clinical practices, so their future influence on ASCs could be either positive or negative. For example, it is not clear how MSOs will adapt, once the U.S. healthcare industry begins shifting from pay-for-service to a pay-for-value model.
