Each new year in healthcare presents its own unique challenges and opportunities and 2014 is no exception.
As healthcare reform continues to take root, new strategies and expanded services can help surgery centers face challenges head-on and seize new opportunities.
"I think from a general standpoint the industry will be looking to higher acuity cases and moving these cases from hospitals to ASCs," says Robert Carrera, president and CEO of Pinnacle III.
Here three CEOs of leading ambulatory surgery center management and development companies weigh in on the best procedures and capabilities for surgery centers to consider adding in 2014.
1. Spine surgery. Spine surgery has been seen as a golden opportunity for ambulatory surgery centers for quite awhile and remains one of the top picks for new services lines to add at ASCs. "Ninety percent [of spine cases] are still done in the hospital. Perhaps 50 percent would be suitable for an ASC from a clinical perspective," says Luke Lambert, CEO of Ambulatory Surgical Centers of America. "These procedures represent new sources of revenue that are relatively untapped."
With the continued progression of minimally invasive techniques, many spine procedures are decreasing in time needed and patients are recovering quickly. There are a number of spine procedures, such as single level anterior cervical discectomy and fusion and foraminotomy, which are now generally accepted as safe in the outpatient setting. For the right ASC environment, properly trained staff and highly motivated surgeons, spine surgery opens the door to a significant opportunity.
Acknowledgement of potential challenges weighed against potential gains allows surgery center leaders to determine whether or not spine is right for their center. To prepare for new specialties, administrators:
• Determine what payers in a certain market will reimburse for each new procedure;
• Evaluate the price of new equipment to determine expected profits;
• Share these numbers with ASC leaders and spine surgeons;
• Decide whether spine surgery is a sound investment.
Payer communication can make or break the success of a new specialty at a surgery center. "There needs to be relentless communication with payers," says Mr. Carrera. ASC leaders need to research every aspect of the procedures they will be adding. What are all of the costs associated with the procedures? Depending on what market a surgery center is in, contract negotiation may involve a great deal of payer education.
2. Total joint replacements. Spine surgery is on the move to the outpatient setting, but this is not the only specialty traditionally relegated to the hospital realm that is becoming an opportunity for ASCs to seize. Total joint replacements are also making their way into ASCs, especially when surgery centers have 23-hour stays.
"Long ago physicians pulled hernias and knee scopes from hospitals to ASCs. Commercial payers now interested in moving whatever they can to a lower cost environment," says Mr. Carrera. "ASCs are in the position to realize excellent margins on these higher acuity cases."
Surgical Management Professionals has added 23-hour stay capabilities at three centers thus far and established a template for doing so. As with adding many new procedures and protocols at surgery centers, the process begins with the physicians. "You need the right physicians, physicians motivated by patient care ant not dollars and cents," Michael Lipomi, president and CEO of Surgical Management Professionals. The right physicians will be involved in a facility that is willing to invest the time and money.
3. Geriatric procedures. Innovative technology and techniques now allow surgery centers to treat more geriatric patients safely. Anesthesia has advanced for patients with more comorbidities and procedures that are common among the Medicare population — such as cataract surgeries — can increasingly come to the ASC.
However, there are still a few challenges with procedures like outpatient spine surgery for this population. Though outpatient spine surgery seems like an obvious win, for both ASCs and patients, the specialty's migration to the outpatient center is not without its hurdles to overcome.
"The big challenge is that Medicare doesn't pay and many commercial payers are reluctant to pay or do so poorly," says Mr. Lambert. ASC leaders are no strangers to reimbursement struggles and receiving adequate and sustainable reimbursement for spine procedures begins with educating commercial payers. To turn CMS we still likely have years of industry lobbying ahead of us.
4. Vascular surgery. Traditionally vascular procedures were too complex for the outpatient setting, but with new technology and a push toward cost-effectiveness, ASCs are able to capture more of these high acuity cases.
Surgery centers most prepared to take on high acuity cases are supported by stellar staff. From the staff's perspective, adding any new specialty involves setting up the right protocols so patients are as comfortable as possible, streamlining the scheduling process and ensuring the entire process goes smoothly all the way through to receiving the correct payment, says Mr. Carrera.
"There need to be physician champions to drive these cases to surgery centers," says Mr. Carrera. Physicians are the spokespeople from a community standpoint. From an internal standpoint, physicians, staff and the managed care coordinator work together to demonstrate to payers that the ASC is a safe and economic environment for performing these kinds of cases.
5. 23-hour stays. Sending patients home too soon is a concern often associated with bringing higher acuity cases, such as spine, neurosurgery and total joint, to the ASC. In states that allow it, adding 23-hour stays is an opportunity to provide an environment designed to make these kinds of patients more comfortable.
At the SMP centers that added this capability the idea was introduced through a clinical and financial briefing presented to the board. "The more we discuss this with physicians, the higher the comfort level," says Mr. Lipomi. Visits to centers that already have 23-hour stays gave physicians and staff a chance to see how the process worked.
As with any new specialty or procedure at a surgery center, it is important to perfect the process before leaping too far ahead. "Do a case, analyze it. Cover every contingency," says Mr. Lipomi. At the SMP centers, the process began with one case a month and slowly built from there. The centers are now accommodating three to five 23-hour stay patients a week. "It takes so long because you don't want to make a mistake. You are under the magnifying glass," says Mr. Lipomi. Surrounding hospitals and payers will be watching closely for the sign of any mistake.
Surgery centers provide patients an alternative to hospital care with higher nurse to patient ratio and lower infection rates. "ASCs are familiar with providing superior service," says Mr. Lipomi. "I definitely think 23-hour stay procedures provide a safer, cleaner and more controlled environment for the patient."
More Articles on ASC Issues:
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5 Ways Single-Specialty ASCs Can Flourish for Physician Owners
5 Tried & True Tactics for Attracting Physicians in an Age of Hospital Integration: 2 Surgery Center Administrators Weigh In
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