Healthcare Reform's Impact on ASCs: How to Navigate 2014
Several industry experts discussed these issues heading into 2014 at the 20th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 25. The panel, titled "The Impact of Healthcare Reform on ASCs and Practices," included CEO of Regent Surgical Health Tom Mallon; President and CEO of Physicians Endoscopy Barry Tanner; Richard Wohns, MD, of NeoSpine; and CEO of Ambulatory Surgical Centers of America Luke Lambert. Anna Timmerman, Associate at McGuireWoods, moderated the panel.
"I think it's an opportunistic time for innovation," said Mr. Tanner. "If healthcare reform is successful, we'll have more patients in the insured pool to care for. If you are in the ASC business, you know you have the highest quality and lowest cost for care. However, I think sitting back and expecting patients to come to you is a huge mistake. You have to be proactive in reaching out to patients."
While the true impact of healthcare reform remains to be seen, surgery centers have dealt with several negative side-effects over the past few years, including specialist and primary care physician employment; patients with higher premiums; and decreasing reimbursement from Medicare and commercial payers. The ACA encourages providers to coordinate care to increase quality and reduce costs, which could be an opportunity for ASCs.
"I think the ACA has given a direction and momentum to the healthcare industry that has caused the market to carve up," said Mr. Lambert. "I think the real opportunity for ASCs is to figure out your place in the region and then position yourself to become part of the organizations and networks."
Mr. Mallon said he's seen an increase in hospitals, health systems and even academic medical centers coming to physicians and surgery centers for alignment. In many markets, surgery centers can provide valuable expertise on cost-effective care and can help hospitals achieve their goals. However, some physicians and ASCs feel a relationship with hospitals is necessary as hospitals acquire primary care physicians and specialists see their referrals re-directed.
"If you are independent and want to stay that way, you have to do something different," said Dr. Wohns. "If you are established as someone who can be part of an accountable care organization, that's an opportunity. The one- and two-physician groups are realizing they might need to join an existing group. Spine surgeons are recognizing that to remain independent they need to work together and create a network for spine and pain care."
Dr. Wohns also discussed the increased need for good data and outcomes tracking to prove the ASC or physician group's value. In the surgery center setting, physicians are often able to take advantage of newer technology as well to improve those outcomes.
"The ASC can be more forward-looking and deal with technology and implant companies to purchase new and innovative technology that hospitals might not be able to because of capped pricing," said Dr. Wohns. "ASCs can partner with the technology or implant companies and offer the implant on a bundled pricing model. You can track and promote the technology for patients who want it."
Mr. Tanner stressed that outcomes tracking and reporting is crucial in gastroenterology groups as well. He is seeing a trend of consolidation among independent gastroenterologists to survive the changes from healthcare reform.
"The reasoning behind consolidating is the larger you are, the more resources you have and more expertise you can bring in, the better position you'll be in to innovate and work with payers," said Mr. Tanner. "We are going to see the emergence of practice management organizations to help the physicians remain independent and focus on medicine."
Physician groups and surgery centers are now faced with the decision about whether to participate in bundled payments, ACOs and in-network contracts. In some geographies, out-of-network is still a viable option; in other markets, providers are becoming creative in how they share risk while optimizing reimbursement.
"An orthopedic group analyzed the cost of care for their joint patients and realized the big spending wasn't in the facility or professional fee, but in the subacute care facility," said Mr. Mallon. "They went to Medicare and said they'd cut the number of days patients were staying at the subacute care facility in half and manage the risk for those patients. They are starting to take on the risk and then capitating the risk with subacute providers."
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