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Futuristic Healthcare: 7 Considerations for Ambulatory Surgery Centers

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Praveen SuthrumAmbulatory surgery centers have the opportunity to incorporate the future of medicine into their care delivery model today, which would put them ahead of the curve tomorrow.

"Medicine is not going away, but the delivery of care is going to move up the value chain," says Praveen Suthrum, President and Co-Founder of NextServices. "The most successful centers will be the ones who are able to look up and incorporate the highest level of sophistication in order to provide care for their patients. Administrators and physicians sometimes fear the uncertainty about where medicine is going in the Untied States, but that uncertainty will be reduced if they are excited about the future. We need to stop seeing ourselves as victims of reimbursement cuts and start viewing ourselves as individuals who can change the way medicine is practiced in the future — then it's exciting."

Here are seven elements to plan for the future of healthcare in ASCs.

1. Robotic technology. The precision achievable with robotic technology allows physicians to transition more complex surgeries into outpatient procedures. The da Vinci Surgical System used for several types of general and urological surgery procedures has made a big impact on the field.

"For example, hysterectomy looks very different today than it did 10 years ago because of robotic technology," says Mr. Suthrum. "It is possible for patients to check in early morning and be discharged at night. If you fast-forward into the future, you'll see more of these procedures being done on an outpatient basis."

However, robotic technology is still a huge capital expense and many surgery centers haven't taken the leap, especially since using the robot doesn't include higher reimbursement from insurance companies. Surgery centers that have purchased robotic technology have a business model that brings high acuity cases into the center to maintain profitability along with quality care.

2. DNA and genetic screening. Today it's fairly uncommon for patients to have DNA samples or genetic screening, but Mr. Suthrum predicts it will become an integral part of patient care in the future. For conditions like Crohn's disease where genetic markers help predict the risk patients have for developing it, physicians can be more proactive about screening and treating patients.

"You'll see labs in surgery centers collecting samples and pathologies for genetic screening," says Mr. Suthrum. "It could have an impact on how physicians diagnose conditions. The cost of sequencing DNA has been steadily dropping from billions of dollars down to $100, and some day it'll only cost pennies. If you look at the future, physicians are going to actively recommend patients with family history of conditions like colon cancer to have their DNA and microbiome tested, and ASCs can make meaningful decisions based on the data of a population."

Depending on the individual patient's risk, physicians might recommend they have a colonoscopy more or less frequently, or even at an earlier age.

3. Imaging technology. New devices are available to make imaging more portable and accessible to patients. For example, the V-scan from GE could allow patients to take an ultrasound image of their heartbeat from home and send the visuals to their physician for review.

"Putting this in the context of the surgery center, a patient can use the device and place that ultrasound over his or her heart and the physician could see what was happening in real time from the ASC," says Mr. Suthrum. "It would change the meaning of a visit. Centers could regularly monitor a patient condition remotely and provide timely alerts that could save lives."

Similarly, data such as a patient's weight or physical activity could be monitored through devices such as an Internet-enabled scale or pedometer and then send information directly to the patient records. Images could also be tracked and stored in the patient's medical record.

4. Electronic health records. Today, EHRs are mainly used as digital storage systems for patient records — they do not have strong analytical capabilities. However, they could in the future assist physicians by analyzing patient data and assisting in the process of care.  

"It's not humanly possible to retain all information we get from the patient," says Mr. Suthrum. "An EHR system can do that. In fact, it can connect the dots between patients and conditions and provide fresh insight to make a clearer medical judgment."

EHR implementation today is a huge expense and takes several hours of time and energy from staff members to fully integrate the new system into the center. However, the technology makes reporting required for quality data easier and serves as the basis for evolving towards the level of coordination of care necessary to treat patients.

"EHR, as a trend, is going to make a big impact on medicine also because visualizing medical data is very important," says Mr. Suthrum. "We see clients of the future being able to access EHR systems and patient records on any device, including the Google Glass. This way physicians can engage with their patients and the records at the same time. EHRs can capture videos and pictures more dynamically and they can be saved for the future."

5. Revenue cycle management. Insurance companies are increasingly focused on risk-sharing payment models, such as accountable care organizations and bundled payments. The reimbursements are also tied to quality of the procedure instead of quantity.

"Companies will hold providers responsible for patient populations and surgery centers are worried that they'll have to coordinate the care of 20,000 patients," says Mr. Suthrum. "How do they manage them and what types of broader trends are there across the patients in a certain geography? How can we use technology to track those trends? I foresee administrators moving up several notches in the type of questions they ask at work."

Medicine has become more data-centric, and as ASCs search for quality and cost data that will drive patient volume, they'll focus their business model around data analytics. Centers struggling to achieve suitable reimbursements might view implementing EHR as the end to their means, but after implementation is when the real work begins.

"For revenue cycle management, Centers must standardize the process and automate it where possible so every aspect of the revenue cycle becomes more predictable," says Mr. Suthrum. "When possible, it shouldn't be done by an individual; people should be saved for tasks at the highest level of sophistication. Staff at the center should invest their time in building the center for the future."

6. Automation and outsourcing. Administrators and physician owners focused on preparing for the future don't dwell on the problems in healthcare of today. While they still see reimbursement cuts and increased administrative tasks, they don't allow these issues to consume their work.

"The most successful administrators finish their work within a certain time and then spend the rest of the time on the center's growth," says Mr. Suthrum. "Technology can provide a greater efficiency. If I want to do something in 20 percent of the time it takes now, I have to standardize the process and find a technology that will automate the task."

He also recommends identifying the areas that you or your center aren't good at — such as materials management or revenue cycle management — and outsourcing them to the experts. As a result, administrators can focus on what they do well and motivate their physicians and staff.

"If centers can maintain or increase profitability, they are not under financial pressures and they can consider more interesting ideas for the future," says Mr. Suthrum. "They can also educate themselves, the physicians and staff members through in-service or online courses to develop better ideas for the business."

7. Futuristic look. More healthcare providers today are changing their waiting rooms or exam areas to become more comfortable for patients and their families. Some model themselves after posh hotels while others take on a spa-like feel. However, Mr. Suthrum argues that ASCs with a futuristic feel will be attractive to all healthcare stakeholders, not just the patients.

"ASCs may not have the resources to purchase a da Vinci robot or other technology, but they might want to save for a few years to afford the expense," he says. "I think it's a better use of the money than getting new chairs for the waiting room. Patients will see the ASC becoming more futuristic and insurance companies will also view the ASC differently. If the patients and payers are excited about the center, the physicians won't have to worry about hospitals taking their jobs. This is what focusing on the future does - it makes physicians feel secure in the present."

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