At the 19th Annual Ambulatory Surgery Centers Conference in Chicago, President and CEO of Surgical Care Affiliates Andrew Hayek gave a presentation about the future of the ASC industry. He discussed several emerging trends and how surgery centers can best prepare for the future.
1. New payment methods. One of the intended consequences of healthcare reform is new payment models, including accountable care organizations and bundling payments. These efforts are focused on driving down the cost of care while maintaining good quality and clinical outcomes.
Health insurance exchanges will encourage insurance companies to compete for patients and may lead to fewer employers offering coverage. "If there is a migration from commercial to state insurance exchanges, you may have a real payor shift and a rate shift," says Mr. Hayek. "In theory, there should be more ACOs, risk by primary care physicians, transparency and bundled payments."
2. 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 Mr. Hayek. "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," said Mr. Hayek. "It's something everyone needs to think about in their markets."
A quarter of surgeons across the country are thinking about employment in some manner, said Mr. Hayek. "Have a direct conversation with surgeons about that. Have them talk to surgeons who have done it and opted out later."
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.
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," said Mr. Hayek. "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."
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