The ambulatory surgery center (ASC) market has expanded exponentially in recent years. In 2018, ambulatory surgery center payment and policy updates have been released by CMS (Centers for Medicare & Medicaid Services). Growth is expected to continue at its highest compound annual growth rate (CAGR) from now until 2022 according to MedGadget, which naturally begs the question: Why are outpatient surgery centers gaining such momentum?
As technology improves and more ASCs become available, the popularity of outpatient services grows. Plus, many of these settings are quite luxurious in comparison to their state hospital counterparts, thus patients often prefer the ASC environment. Furthermore, advanced technology has resulted in shorter hospital stays and fewer complications, so it only makes sense that care adapts to allow patients to go home sooner following surgery. Core principles behind the use of ASCs include:
- Keep hospital costs as low as possible
- Save the patient time and provide convenience
Inevitably, with significant growth also comes substantial changes in terms of ambulatory surgery center payment rates, policies, procedures, regulations, and standards. We looked to leading industry professionals and resources to find out what 2018 and beyond has in store for the world of ASCs and this is what we found out…
Ambulatory Surgery Center Payment Changes and Final Rule Released by CMS
On the first of November, the Centers for Medicare & Medicaid Services (CMS) released its final 2018 ASC rule. The majority of provisions are intended to reduce administrative burdens and maintenance costs for ASCs. Key takeaways from this rule include the following:
- Ambulatory surgery center payment rates are going up across the board with a 1.2 percent increase in 2018.
- Total knee arthroplasty (TKA) has been removed from the inpatient-only list (IPO) – however, it awaits approval for ASC payment. In addition, five other procedures have also been removed from the IPO list.
- Implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey has been delayed.
- The CY 2019 payment determination criteria no longer include three Ambulatory Surgical Center Quality Reporting (ASCQR) Program quality measures.
- Six Hospital Outpatient Quality Reporting (OQR) Program quality measures have been removed.
Physician Practices Partner to Provide Care in Outpatient Surgery Centers
An emerging theme among ASCs is the partnership of several physicians to provide care at the same facility. The Ambulatory Surgery Center Association (ASCA) just released their quarterly publication for doctors that provide care at outpatient clinics entitled, “ASC Physician Focus”.
One of the main topics in this fall edition was the concept of consolidation and partnership within the ASC setting. Henry Bloom, founder, and president of The Bloom Organization foresees the future of ASCs to include large physician groups and partnerships. Bloom offered the following statement in the latest edition of ASC Physician Focus:
“The lifeblood of an ASC comes from its physician partners and, in turn, the affiliated practices. Likewise, ASC management companies, private equity and local health systems provide the management, leverage and support needed to maximize long-term stability. Whether you are on the clinical or business side of the equation, it’s the party that best delivers real value to their partnership and passes value onto patients that will have the most success.”
Within the collaborative approach to outpatient surgery, an ongoing challenge is for ASCs to fill their physician schedules with non-owner physicians. The benefit for the outside provider is the ability to provide high-quality care by using technologically advanced equipment at the facility without the overhead and investment. Professionals that find doctors to fill available time slots share their experiences and offer advice for meeting this demand for physician services in the ASCA publication:
- Don Bartnick, Chief Executive Officer of Annapolis Surgery Center in Annapolis, Maryland, and Principal in Donveritas Consulting writes: “Surgical scheduling for peak performance is an extremely challenging task requiring strategy, organization, flexibility, intelligence data, insight, persuasion, and common sense.”
- Thomas Feldman, Chief Executive Officer of the Center for Health, Ambulatory Surgery Center in Peoria, Illinois offers his strategy: “I try to target non-owners with different information based on their needs. I speak to the surgeons about specific equipment needs and preferences with regard to staff numbers and skill set.”
- Scott Glaser, MD, Co-Founder and President of the Pain Specialists of Greater Chicago in Illinois summarizes the importance of first impressions with physicians, “When you get right down to it, we’re in a service industry. The first time that non-owner comes to your ASC, you need your key personnel greeting them at the door with open arms.”
How Ambulatory Surgery Center Procedures and Policies are Changing
Patient criteria for outpatient surgery have expanded.
As the patient care technology and physiological monitoring capabilities improve at the outpatient centers, “we find ourselves more willing to provide care to those patients who, only a few short years ago may not have been a suitable ASC patient,” explains Stanford R. Plavin, MD, anesthesiologist, owner of Technical Anesthesia Strategies and Solutions and ASCA board member. Patients with obesity are among the most common who at one time were not considered good candidates for outpatient surgery but are now being accepted and demonstrate favorable outcomes.
Patients are being safely discharged just one-day post-TKA.
Another significant change is the rise in safe discharges of total knee arthroplasty (TKA) patients just one day after their procedure according to a new study published in the Journal of Arthroplasty.
This particular study considered the clinical data of approximately 2,300 Medicare patients that had a unilateral TKA. Of that number, about 1,500 were discharged to home within a day of the surgery. The results showed no increase in 30-day readmissions or 90-unplanned readmissions for those discharged within 24 hours versus the others that were discharged on day two or later.
Outpatient surgery services will be necessary if hospitals wish to compete in the future market.
Ambulatory surgery options are becoming a necessity as hospitals are forced to transition to a value-based payment model. Chris Bishop, Regent Surgical Health CEO, shared his insights on this focus shift during the Becker’s Hospital Review 6th Annual CEO + CFO Roundtable that was held on November 13. Bishop stated:
“When you are going to generate 75 percent of your revenues via some type of value-based reimbursement methodology, you have to have the lower cost setting to deliver that service in.”
Bishop talks about the estimate that by 2026 the number of joint replacement surgeries will have doubled which are increasingly being done on an outpatient basis – along with multiple spinal procedures. In the future, if your hospital does not offer patients an outpatient joint replacement or spinal surgery option – a competitor or a large orthopedic practice will have already dominated the business for your area and you will not have any shot at those profits.
Multiple practices use the same ambulatory surgery center which improves the standard of care.
One such example was illustrated in a recent article published by Ophthalmology Times, a Modern Medicine publication. The article discussed how multiple cataract surgeons delivered care with greater safety, efficiency, and speed along with excellent postoperative outcomes by spreading the highest standards of care through the use of one facility.
These results do not come without significant challenge, as the article states, “Overcoming these challenges requires a systematic approach that leverages the leadership and experience of early-adopting technology champions, employs consistent and comprehensive communications with all participating practices, and provides administrative support to secure reimbursement.”
At The SSI Group, we help ambulatory surgery clinics make better business decisions through the use of robust analytic solutions. As such, we will continue to monitor and report on the updates and changes that affect the ASC sector of healthcare services.