On Saturday, Oct. 26 at the 20th Annual Ambulatory Surgery Centers Conference in Chicago, a panel of experts discussed some of the biggest opportunities, threats and trends for ambulatory surgery centers heading into next year.
The panel included John Venetos, MD, of John Venetos Ltd.; R. Blake Curd, MD, board of directors chairman for Surgical Management Professionals; Edward P. Hetrick, president of Facility Development & Management; and Scott Glaser, MD, co-founder and president of Pain Specialists of Greater Chicago. The panel was moderated by Becker's Healthcare Publisher Scott Becker.
Accountable care organizations
Dr. Venetos began by discussing the successes pioneer accountable care organizations were able to show this past year. All improved quality, but only 13 were able to improve enough to receive incentive payments. He also discussed his group's success with a physician-led ACO.
"We have been able to reduce costs," said Dr. Venetos. "I think ACOs are here to stay and they will change the way we practice medicine."
Dr. Curd concurred, noting that the number of people who need medical care is not decreasing. There won't be a lack of patients for physicians to see; rather they are now learning how to navigate the new healthcare system.
"I'm optimistic about the future simply because we know a little bit more about what is going on each day," said Mr. Hetrick. "You are able to make better judgments and better decisions than you were the day before. I think overall the course of the next year, as things are better defined, you will be able to make better decisions and point your center in the right direction."
Dr. Glaser mentioned his excitement to care for patients, especially as technology evolves to improve treatment and outcomes. However, downward pressure on reimbursement continues to plague specialists and make providing medical care frustrating. As ASCs continue to struggle with reimbursement rates from payers and insurance companies, some hospitals are now forming their own risk-based system for medical care.
"We are seeing a bigger impact in healthcare systems becoming insurers," said Mr. Hetrick. "As they are signing up patients and developing ACOs, they are buying physician practices and groups. One of the trends I see, as healthcare systems are acting as insurers and going out to look at their coverage, a big change will come for their relationship with ASCs. Do you become an HOPD, 51 percent partner or just an affiliate?"
While reports show statistically more physicians are becoming employed — either by hospitals purchasing their practices or signing a hospital contract right out of training — but there are still regions of the country where independent physicians are able to survive and thrive.
"For us, right now, it's a steady state," said Dr. Curd. "The folks that are fiercely independent remain so. We haven't had any physician groups be bought or purchased. We look for the fiercely independent warrior surgeons when recruiting. We try to do our best and maintain reimbursement levels, but we expect downward pressure at some point and we're preparing for that."
One of the big threats Dr. Glaser sees to physicians remaining independent is guidelines coming from commercial payers. As a pain management physician, many of the procedures and treatments he provides fall within a reasonable range where patients can afford them regardless and those patients are seeking out the best physicians for their care.
"Pain isn't something that is cured; it's managed," said Dr. Glaser. "I think we have an excellent chance to remain independent because if we are managing our patients properly, most of our referrals are from friends and family. We're seeing new patients come in every month."
There are some states that are harder to remain independent in, such as New Jersey. Mr. Hetrick mentioned many hospitals in those markets are purchasing physician groups. In some cases the physicians were allowed to continue performing cases in the ASC but they couldn't be partners in the facility.
Commercial payer contracts
Reimbursement rates are key for physicians and surgery centers to remain independent. While some groups, like Dr. Venetos' group, can develop shared savings programs to incentivize quality and cost-effectiveness, other organizations are looking at different ways to negotiate individual payer contracts.
"We continue to talk with the lowest paying payer and educate them about how they are not at the same level as the others," said Dr. Curd. "Sometimes we are able to achieve higher rates. We try as hard as we can to make sure the payers are reasonable levels."
As the type of insurance patients have changes to higher premium plans or defined contributions, ASCs are starting to rethink their strategies. Some are still able to go out-of-network while those opportunities aren't available in others. There was mixed thoughts about whether the country is headed toward a single-payer system and the potential ramifications.
"If we end up with a single-payer system, we won't be able to afford healthcare," said Mr. Hetrick. "I think we'll end up with a hybrid of payer plans. What we've discovered is that information is king. We are able to provide relevant information in the centers we manage to negotiate contracts."
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