Ambulatory Surgery Centers (ASCs) are experiencing an increase in numbers, procedures and the ability to provide services for Veterans. In 2017 there were 5,602 Medicare certified ASCs. And, they’re seeing new challenges, and calls for oversight. We take a look at some recent news about this growing industry.
Are studies about ambulatory surgery centers (ASCs) always accurate? Becker’s ASC Review has a recent article about how “The percentage of freestanding ASCs within 250 yards of main hospital buildings is large enough to influence analyses of observational studies using ambulatory surgery datasets, researchers found.” The researchers caution that “Researchers using U.S. national data should not assume ambulatory surgery reported as performed at a hospital has been performed within the hospital; and also that hospital-affiliated freestanding surgery centers are more than a five-minute walk for anesthesia and operating room personnel from the hospital.”
What are the top challenges ASC managers face? Six ASC administrators and executives recently discussed the top challenges facing their centers for Becker’s ASC Review. Here are 3 top takeaways from that article (note that All administrators featured in this article will speak on featured panels at the Becker’s ASC 25th Annual Meeting, Oct. 18-20 in Chicago.):
- We are facing many challenging issues, from competing with larger hospitals for not only patients but also for employment of the best clinical staff. Perhaps our biggest challenge is securing reasonable payer contracts with the health plans in our area. As we all know, historically, ASC payments have lagged well behind hospitals and HOPDs (Hospital Out-Patient Departments). This has been both a blessing and a curse. We like being the low-cost, high-quality provider in our community and it helps us with payers and patients. — Raymond Hino. Administrator of Skyway Surgery Center
- With more procedures being added to the ASC payable list, we will need to not only sustain our current volume, but have the ability to take on an increasing population. — Heather Hilgendorf-Cooley. Administrator of Spring Park Surgery Center
- A top challenge is capturing our utilization and capacity as we are not on an EMR. We are looking at ways to generate reports from our EPM System. We keep a “shared calendar” in outlook to which all the surgical schedulers have access. — Kris Kilgore. Administrator of Surgical Center of Michigan
Given some common ASC challenges, what can managers do to boost business? “In a small study of ambulatory surgical centers across the country, Johns Hopkins quality care researchers found that publicly listing the prices of common operations, such as uncomplicated labor and delivery and tonsillectomies, generally increased business, revenue and patient satisfaction,” reports the Eurek Alert.
The research cited is available at the National Center for Biotechnology Information website, and in its abstract states that, “Among five centers that reported their patient volume and revenue after adopting pricing transparency, patient volume increased by a median of 50 percent (range 10-200%) at one year. Four centers (80%) reported an increase in revenue by a median of 30 percent (range 4-75%), whereas three centers (60%) experienced an increase in third-party administrator contracts with the average increase being seven new third-party administrator contracts.
What about expanding to offer good surgery center prices to veterans? A release at the Ambulatory Surgery Center Association (ASCA) detailed in late Spring how thanks to the new VA Mission Act, members may now more readily continue offering “cost-effective surgical and preventive care, including orthopedic, endoscopic, pain management and other important procedures, to veterans.” The release also noted that collections for ASC’s serving veterans often resulted in long waits for payments but that the new bill enables “5,600 Medicare-certified ASCs nationwide to continue to deliver efficient community care to veterans through a reliable claims process that requires claims be reimbursed in 30-45 days for non-VA providers.”
Is more oversight for Ambulatory Surgery Centers on the way? USA Today recently took a look at deaths at surgery centers. Explaining that regulations vary from state to state and that 17 states have no mandate to report patient deaths, the article details some odd occurrences in Arkansas, and points out that Hospitals do vigorously investigate deaths. Calling this “gaps in oversight”, USA Today also observes that, “no rule stops a doctor exiled by a hospital for misconduct from opening a surgery center down the street.” The long article is a team effort between USA Today and Kaiser Health News. A review of ambulatory surgery center related posts at the Kaiser site shows a history of reporting on the industry and in particular some suspicious deaths at the nation’s surgery centers. CMS — Centers for Medicare and Medicaid Services — has a page at their website dedicated to policies for ASCs to become eligible for payments. For its part, the Ambulatory Surgery Center Association also posts federal regulations on a page at its site, though this does not address the state reporting concerns raised in the first article.
PBS had a segment in 2014 noting that ASC’s perform “23 million surgeries in the U.S. per year, “and that “larger questions are being asked about those centers.” The report was in part prompted by questions about the death of Joan Rivers at an ASC. You can watch the 5-minute segment below:
Meanwhile, more ASC’s are increasing their range of services. Becker’s ASC Review recently carried an article by Chris Bishop, CEO of Regent Surgical Health focusing on how “a growing number of surgery centers are successfully performing cardiovascular procedures”. Regent Surgical Health, a company that seeks successful surgery center partnerships between hospitals and physicians, stresses the advantage for hospitals in doing more cardiovascular work. “Moving such cases away from the hospital setting offers advantages across the board. Procedures can be done at lower cost, with quicker turnaround times, and the move helps alleviate scheduling delays for hospital ORs, freeing them to expedite higher acuity cases while still producing quality medical outcomes, and often, a more positive patient experience.” At their website, Regent explains their mission like this: “We continually improve and evolve the ASC model based on changing market conditions, to stay ahead of emerging trends. From this vantage point, the company has developed proprietary ASC ownership models that give both physicians and hospital administrators what they need to ensure long-term clinical and financial success.”
Read our ongoing coverage of Ambulatory Surgery Centers News as we work with our ASC clients to continue to develop SSI ASC Analytics — an expansive suite of intuitive analytics, reports and dashboards that helps guide managers to their most pressing issues and enables them to drill down for a comprehensive view.