Ambulatory surgery centers (ASCs) provide patients the option to receive surgeries, often as complex as total joint replacements, in centers that are outside of the traditional hospital setting and often cost far less than hospital-based surgeries.

With the current economic uncertainty in the healthcare realm, more patients are moving towards receiving care at ASCs. Subsequently, new challenges are being faced that may lead to regulation and legislation to make standalone outpatient clinics more “hospital-like”. Let’s review.

Ambulatory Surgery Centers

Will new legislation and policies make ambulatory surgery centers more like hospitals?

Legislation Could Help Ambulatory Surgery Centers Stay in Business

Healthcare Dive reported recently about a new bill, the Ambulatory Surgical Center Quality and Access Act of 2017, which would require Centers for Medicare and Medicaid Services (CMS) to publish the same side-by-side comparisons for ASCs and hospital outpatient departments (HOPDs). Additionally, the bill would add a representative for ambulatory surgery centers to the CMS Advisory Panel on Hospital Outpatient Payment. According to the article, yet another provision would “mandate CMS disclosure of which of six exclusion criteria was responsible when a procedure is barred from the ASC approved list.”

The article states that the Ambulatory Surgical Center Association (ASCA) is in favor of the bill, citing it would, “close the gap between reimbursement at ASCs and hospital outpatient departments (HOPDs) by using the same inflation measures for both.” According to the CEO of ASCA, William Prentice:

“Without a fix, the disparity between ASC and HOPD payments will continue to widen, potentially reducing access to ASCs and leaving Medicare beneficiaries with only higher options for their care and increased Medicare program expenses.”

The ASCA reports that the Medicare coverage for ASCs is a mere 49 percent of what HOPDs are paid for the same procedures. This figure is down from 86 percent in just 2003. Because of this disparity, ASCs have difficulty staying in business and often they sell out to hospitals and are converted to HOPDs.

Overnight Stays in ASCs Approved by Florida Senate

Florida is a state moving forward with legislation that makes outpatient surgery centers more like hospitals, in the respect that patients would be allowed to stay overnight under the new law. Florida Politics recently reported on a bill that passed the senate that allows people to stay overnight in ambulatory surgery centers. According to the article:

“SB 222 by Sarasota Republican Rep. Greg Steube would allow patients to stay up to 24 hours at ASCs, a type of medical facility dedicated to less complicated, generally elective surgeries. ASCs don’t provide primary care or diagnostics and generally require patients to be referred in by a physician once they have decided that surgery is part of their treatment plan.”

Also contained in the bill are provisions that would allow for “recovery care centers,” which are different types of facilities where patients can stay up to three days.

Are “Mini-Hospitals” Going to be Oregon’s Solution to Reduce Healthcare Costs?

A recent bill introduced in the state of Oregon, House Bill 2664, would allow outpatient surgery centers to act as inpatient surgery centers by allowing patients to stay up to 52 hours after surgery.

The Statesman Journal reports that the major concern organizations and skeptics of the legislation have is the fact that hospitals must uphold quality care standards and are under tight scrutiny and regulation by national organizations, such as Joint Commission. However, the bill does not hold surgery centers to the same community, regulatory and insurance standards as hospitals.

A recent article published in the Lund Report cites that two major hospital systems, Salem Health and Asante, are opponents to this bill in Oregon. Roy Vinyard, the president and CEO of Asante states: “We feel strongly that this issue has not been fully vetted. This extended-care center is in essence a mini-hospital.”

At The SSI Group, we provide software, known as Medibis, that helps ambulatory surgery centers make better business decisions through meaningful analytics. We will continue to monitor and report on pertinent news about ASCs that affects our clients. Learn more about our analytics solution for standalone outpatient clinics.