I don’t think it makes much of a difference here. If my practice was all traditional Medicaid it would probably be exactly the same revenue. It pays a little better than Medicare. Not enough to worry about.
Yes, I do implants/lateral SI/mild, etc at an ASC or HOPD. I have a small ownership in an ASC which is fine since it is a fairly large 6 room center. That is fully optional and you technically lose money for time doing anything at a facility vs staying in your office if you are in private practice and don’t have ownership.
Example:
Pump implant pays a pro fee of like $500 Medicare. You are better off hanging out in your office doing anything else or taking time off to enjoy the outdoors - unless, you are an owner and the facility is profitable. It might not be. Or you are actively trying to build up your surgical practice for the chance to be offered ownership.
The facility I bought in was already profitable. So me joining, is accretive. After my implant costs, I’m not really increasing overhead otherwise and then I really turn up the profitability. Commercial DOES pay much, much better on the facility side. Some of the case profit is outlandish. But that gets diluted out to the other docs.
Hospital employed you can do big cases or not. However, you want to get your units.