Hospital Employment, Office-Based Procedures & Specialist Shortages: How They Impact Ambulatory Surgery Centers
On Oct. 25, 2014 at the 20th Annual Ambulatory Surgery Centers Conference in Chicago, a panel of physicians and industry experts discussed how overall healthcare trends are impacting ambulatory surgery centers.
The panel, titled "Which Specialties Are Still Great for ASCs? Which Ones Should ASCs Eliminate Today? Will Hospital Employment Kill ASCs? What ASC Problems are not Fixable?," included President and CEO of the Mississippi Valley Surgery Center Michael Patterson, Lawrence Kosinski, MD, of Elgin (Ill.) Gastroenterology, and Fred Davis, MD, clinical assistant professor at Michigan State University, College of Human Medicine. Publisher of Becker's ASC Review, Becker's Hospital Review and Becker's Spine Review Scott Becker moderated the panel.
Here are the trends the panelists discussed:
1. Moving procedures from the hospital to the surgery center and from the surgery center to the office-based procedure space
2. Physician employment
3. Entrepreneurialship among young physciians vs. experienced physicians
4. Physician and specialist shortages
5. Consolidation within the industry
"Most of the gastroenterologists coming out of school today are going into the private practice, but they want the same perks as the hospital-employed physicians," said Dr. Kosinski. "When bringing on new physicians, our biggest challenge is making sure we are bringing in a person with an entrepreneurial spirit who will be invested in the ASC."
While the trend over the past few years has been toward hospital employment, now many of the initial contracs are coming due and physicians are seeing their compensation drop with the second contract. As a result, some are trying to decide whether going back into private practice is a viable option. "We are entering an era where surgeons are much more nomadic," said Dr. Davis. "They are not tied to their first practice. They can move out or in more easily than our generation and that's what's allowing them to be flexible."
Dr. Kosinski described his practice model strategy to remain independent in the future. He created a project around IBD treatment and collected enough data to show payers the cost and quality advantage of his center's coordinated care. Since then, his group successfully negotiated a shared savings program with a major insurance company.
Dr. Davis's strategy also collected data and worked with payers to demonstrateg savings. He had a relationship with one of the largest HMOs in his marketplace to develop a program for the most complex and costly pain patients; his group received a stipend as well as a fee for service to manage care for these pateints.
"We put this program together and demonstrated a 50 percent global healthcare savings on these patients," said Dr. Davis. "You have to establish yourself as high quality."
Mr. Patterson touched on the challenge many surgery centers face as patients take on higher premium insurance plans. "Now people who have higher premiums are trying to stay healthy and avoid undergoing more costly procedures," sahe said. "Nothing drives change more so than people having to pay their own bills. I think you are going to have to have transparency in pricing, which will drive better quality."
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