The push for site-neutral payments — reimbursing providers at the same rate regardless of the site-of-service— has picked up momentum in Congress and remains a key point of advocacy for ASC leaders in Washington.
At Becker’s 23rd annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference June 11-13, a panel of independent ASC leaders said the shift, if and when it arrives, would be the most significant structural change the sector has seen in years.
“Site-neutral payments are coming because America as a country cannot afford to have the kind of healthcare costs that we are having and be competitive in the world,” said Faisal Rahman, PhD, member and owner of Munster (Ind.) Surgery Center. “It is not simply going to be surgeries pushed out of the hospitals. Technology is such that 95% of the cases currently can be done on an outpatient basis. And if you have a step-down facility, you can do 99% of the cases outside at a much lesser cost.”
He described site-neutral reform not as a favor to ASCs but as a fiscal inevitability driven by the same cost pressures that have made the current system politically unsustainable.
The case for ASCs in that environment is straightforward on paper. Independent centers have documented lower infection rates, faster throughput and a patient experience that hospital outpatient departments have struggled to replicate. Kevin Plancher, MD, founder of Plancher Orthopaedics in New York City and an independent ASC owner, argued that those advantages only translate into durable market position if centers can prove them with data.
“We have to lead with outcomes as independent ASCs,” Dr. Plancher said. “We have to show that we believe what we say and we have the data to prove it.”
That argument connects directly to the site-neutrality debate. The political and policy case for equalizing payments across settings rests in part on the claim that lower-cost settings deliver equivalent or better care. ASCs that can demonstrate that with outcomes data are better positioned to benefit from the shift — and to defend their reimbursement once it arrives.
John Lucio, MD, regional chief medical officer of SSM Health in Jefferson City, Mo., came at the question from a health system vantage point. He said the centers most likely to capitalize on site-neutral reform are those that have already done the internal work — on workflow, physician alignment and capital investment — to handle additional volume without sacrificing the efficiency that makes the ASC model compelling in the first place.
“It’s going to require a lot of discipline and some significant capital investment in order to stay competitive,” Dr. Lucio said. “I see ASCs actually being successful in the next few years, depending on how they structure their organization.”
Tricia Wollam, administrator of Alliance Surgery Center in Traverse City, Mich., said the operational foundation has to come first. Her center is a three-OR, orthopedic-only facility that has stayed independent by keeping physician owners closely informed and managing costs at the line-item level rather than relying on volume to cover margin.
“Independence is earned every day,” Ms. Wollam said. “I think ASCs, independent ASCs, are not in trouble. We’re actually in demand. And I think if you do it right, you can thrive.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.