An Evolving Industry: 6 Trends in Ambulatory Surgery Centers

Here are six trends ambulatory surgery centers should be aware of and adapt to in the coming months.

1. Consolidation and physician employment. Hospitals are employing physicians at a higher rate than in the recent past, focusing on primary care physicians. "There is a tremendous battle to control primary care physicians in the market, and if you lose control of them you are at risk," said Andrew Hayek, president and CEO of Surgical Care Affiliates. "If you control them, you are ready to be an ACO. It's an opportunity as well as a threat."

Surgery centers can map their referral patterns and see how much of their referral base can be aligned in the community. "We think a lot about how to help keep independent physicians independent and what we can do to serve the folks we are depending on for referrals," he said. "It's something everyone needs to think about in their markets."

2. Providing service for self-fund employers. About 60 percent of U.S. companies are self-funded rather than traditional insurance under the ERISA laws, and more are moving towards self-funding because of the Affordable Care Act, said President of Surgical Notes Jeff Blankinship.

"Self-funding allows employers and their administrators to 'write their own rules' since it's the employer's money that's paying the claims, thus they can be very creative in exploring new ways to manage claims costs," he said. The flexibility allowed by self funding drives patients into centers of excellence providers at lower cost points. ASCs are a natural fit for self-funded employers and their administrators to partner with in these kinds of creative claim cost management issues, he said.

"As for traditional insurance from Blue Cross, UnitedHealthcare and others," Mr. Blankinship said, "they are not interested in these kinds of programs because they fly in the face of their hospital system partners."

3. Risk sharing. Insurance companies are increasingly adopting models that force patients and providers to share more risk than before. Patients are seeing high deductible plans in an effort to dissuade discretionary health spending. This could mean they would choose a lower-cost setting — the ASC — for outpatient surgery, Mr. Hayek said.

Insurance companies and providers are also partnering with primary care physicians to take on capitated risk, which has worked well.

"Hospitals are buying primary care along with payor groups," he said. "People are employing or partnering with primary care physicians to bend the cost curve. Pay a lot of attention to whether this is happening in your market and partner with these types of entities that control where care is given."

4. Developing a more comprehensive coverage. Surgery centers traditionally had an extreme focus on one specialty, but now they are expanding to perform more comprehensive services. They are increasingly including an education facility, rehabilitation, recuperation rooms and retail components.

"You are starting to see surgery centers strike deals with CVS or other pharmacies to bring medications onsite," said Andrew Quirk, national director of Skanska USA's healthcare Center of Excellence. "Wellness is also becoming a part of these facilities. Patients can come in and receive education, undergo rehabilitation or work out in the same facility."

The idea is that the patients can do everything at a single location. "The facility wants to educate people who are coming into a new healthcare environment, including the uninsured and the primary care physicians," he said. "It's really all about the consumers."

5. Creating enhanced patient flow. Freestanding surgery centers are constantly looking for ways to enhance patient flow and optimize efficiency. This occurs within the building and extends to the parking lot to ease a patient's point of entry.

"Patients go to a surgery center because they are looking for a better patient experience," said Marisa Manley, president of Healthcare Real Estate Advisors. "They want to be in and out in a shorter time and ASCs deal with a smaller patient volume, so patients aren't likely to be lost in the system. They also have an easier time parking, and sometimes that's a big deal."

Surgery centers also have an advantage because there is less bureaucracy involved, which gives the center a different feel. "If you are a physician group building a new facility, you can take workflow for the physicians and experience for the patients into account as you build the center," she said. "Whether it's a community center, high end specialty practice or another type of facility, you want to make sure you are planning the workflow so physicians can maximize turnover time and create constant scenes of success."

6. Becoming Energy efficient. Both new and mature surgery centers are taking steps to save energy and become more sustainable. They are using energy efficient equipment, more windows to allow in natural light and efficient building designs. However, they are not necessarily achieving LEED certification for their efforts.

"I think it's a good sign that people are becoming smarter and living a more sustainable lifestyle, with elements of the smart building," Mr. Quirk said. "Taking advantage of natural daylight is becoming the norm in building design arenas, but the LEED certification costs money that facilities don't want to spend. They can still realize upsides to their margins without the designation."

New facilities are taking advantage of these things and building green from scratch; mature facilities are retrofitting with energy upgrades to make sure their generators and boilers are working at the most efficient level possible.

More Articles on ASC Turnarounds:
Physician Recruitment Trends for ASCs: Q&A With Paul Eiseman of Regent Surgical Health
6 Points on Effective Spine Center & Surgeon Marketing
Developing a Culture-Based Workforce: Top Healthcare Workplaces Share Best Practices

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