01
Can it move?
Policy and site-of-service eligibility.
Surgical Strategy
Surgical Site-of-Care Opportunity Blueprint
Know which cases should move, which should stay, what the opportunity is worth, and what must change before you act.
A four-week executive consultation that identifies which surgical volume should move, which should remain in the current setting, what the modeled economic opportunity is, and what must change before leadership acts.
- Physician-led
- Executive consultation
- Orthopedic enterprises
- Fixed scope
Who it is for
Built for physician-led orthopedic enterprises
Organizations
Independent or PE-backed orthopedic enterprises, orthopedic MSOs and platforms, physician-owned ASCs, and physician enterprises participating in hospital-ASC joint ventures.
Executive sponsors
CEO, president, CFO, COO, ASC executive, and physician board.
Clinical sponsors
Orthopedic medical director, physician president, and high-volume surgeons.
The executive problem
Eligibility is not the decision
Orthopedic leaders are being asked to make increasingly consequential site-of-care decisions as surgical eligibility, payer policies, ASC capacity, physician practice patterns, and economics evolve at different speeds.
The central question is not simply whether a procedure can move to a lower-acuity setting. Leadership must determine whether a specific patient cohort should move, whether the payer will support that setting, whether the organization can execute safely and efficiently, and whether the economics justify the change.
Before
Site-of-care decisions may be distributed across clinical judgment, reimbursement analysis, payer policy, ASC operations, physician preference, and finance.
After
Leadership sees which procedure cohorts warrant action, which should remain in the current setting, what the modeled opportunity is, what assumptions drive the estimate, and which payer, operational, or clinical constraint must be resolved before acting.
Decision model
Six linked executive questions
02
Should this patient cohort move?
Clinical appropriateness and patient-selection considerations.
03
Will the payer support it?
Coverage, authorization, network, and reimbursement feasibility.
04
Can the operation execute it?
Capacity, anesthesia, staffing, equipment, implants, recovery, transfer, and workflow readiness.
05
Is the economics worth it?
Site-specific reimbursement, contribution economics, incremental operating requirements, and addressable volume.
06
Will the organization adopt it?
Physician alignment, practice-pattern variation, and execution readiness.
Deliverables
Four executive assets
Asset 1
Opportunity Map
Procedure-level view of current site-of-care distribution, potential site alternatives, external leakage, and meaningful physician and practice-pattern variation.
Asset 2
Economic Case
A modeled Site-of-Care Economic Opportunity Case for each selected procedure. Where data are available: current annual volume, site distribution, addressable migration volume, Medicare economics, one selected commercial payer, facility contribution, major implant and device considerations, incremental operating requirements, ASC capacity requirements, modeled annual opportunity, confidence level, and recommended action. Modeled assumptions are labeled separately from observed client data.
Asset 3
Clinical & Operational Readiness Assessment
Patient-selection considerations, payer friction, ASC capacity, anesthesia, staffing, equipment, implants, recovery capability, scheduling, transfer arrangements, and workflow constraints. The purpose is not to maximize migration; it is to identify where migration is appropriate, where it is not, and what must be true before execution.
Asset 4
Executive Action Portfolio
Each procedure cohort receives one of five recommended actions, so leadership sees a decision rather than a list of findings.
Accelerate
Evidence supports greater use of the alternative site of care.
Preserve
The current pathway remains appropriate.
Unlock
The opportunity appears attractive, but an operational constraint prevents execution.
Renegotiate
Clinical and operational conditions support change, but payer economics or contract terms do not.
Investigate
Evidence is insufficient for a confident decision.
Decision confidence
Every recommendation carries a confidence state
High confidence
Strong clinical, financial, payer, and operational evidence.
Moderate confidence
Direction supported, but assumptions or data gaps remain.
Exploratory
Insufficient evidence for a management decision without further validation.
Engagement structure
Founding Blueprint scope
- One orthopedic service line
- One ASC or defined surgical site-of-care network
- 5–10 high-value procedures
- Medicare plus one selected commercial payer
- Up to four weeks from receipt of agreed data
- Executive readout and 90-day action plan
- No EHR integration, no enterprise software implementation, no new IT deployment
Minimum data request
CPT/HCPCS, procedure volume, surgeon, payer, current site of service, reimbursement/allowed amount, facility cost or contribution margin when available, authorization/denial information when available, ASC utilization/capacity, and major implant/device costs when relevant.
Unavailable data are treated as explicit assumptions and lower confidence rather than being presented as observed results.
- Phase 1Executive Alignment
- Phase 2Evidence & Economics
- Phase 3Clinical & Operational Review
- Phase 4Executive Decision Session
Boundaries
What this is not
- Not a blanket recommendation to move cases into an ASC.
- Not a generic CMS code review.
- Not a replacement for individual physician judgment.
- Not a utilization-management substitute.
- Not a guaranteed savings analysis.
- Not a software implementation.
The analysis supports executive and physician decision-making and does not replace patient-specific clinical judgment.
Investment
Founding Blueprint Engagement
$12,500 fixed fee
Includes one ASC or defined site-of-care network, one orthopedic service line, 5–10 procedures, Medicare plus one selected commercial payer, all four executive assets, an executive readout, and a 90-day action plan.
Multi-site, multi-market, and portfolio engagements are scoped separately.
Why ClinEfficiency Pro
The full decision chain, connected
Most site-of-care analyses stop at eligibility, reimbursement, or operational planning. ClinEfficiency Pro connects the full decision chain: policy eligibility, patient appropriateness, payer feasibility, operational readiness, site-of-care economics, and physician adoption.
The outcome is not another report. It is a defensible executive decision about where surgical care should occur, what the decision is worth, and what must change before the organization acts.
Entry point
30-minute Site-of-Care Opportunity Review
The review is a qualification step, not free consulting. Leadership brings one service line, one site-of-care question, and 3–5 procedures of current interest. Together we determine whether a Blueprint engagement is warranted.