Neal Kaushal, MD, a gastroenterologist from Sonora, Calif., joined Becker’s to discuss the strategies that are helping and hurting ASCs amid the growing CRC demand.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are ASCs adapting to the growing demand for CRC screenings, and what strategies are proving most effective?
Dr. Neal Kaushal: ASCs are adapting to the growing demand for CRC screenings by increasing patient access and procedure volumes. “Open access” endoscopy programs are becoming more popular, and this will be a growing trend in providing more widespread CRC screening programs as well as keeping endoscopy schedules full for gastroenterologists.
Additionally, integrated health systems are also recognizing the importance of providing streamlined and efficient outpatient GI care, and are thus investing in ASCs heavily. By shifting elective outpatient procedures away from the hospital/hospital outpatient department setting, health systems are able to provide an improved patient experience as well as capitalize on more favorable reimbursements in the ASC settings for elective low-risk procedures.
Q: What challenges are ASCs facing as more procedures migrate to outpatient settings, and how are they addressing these hurdles?
NK: One of the biggest challenges facing ASCs nationwide is staffing considerations. This can include nursing care, endoscopy technicians and anesthesia providers. One common practice model to address anesthesia challenges is the implementation of CRNAs to provide sedation for elective outpatient procedures. In the ASC setting, this can generally be achieved using a higher ratio of CRNAs to supervising physician anesthesiologists, thus allowing ASCs to run multiple procedure rooms concurrently to meet increased demand for services.
Travel nursing has also increased in popularity significantly and can be useful when employed in certain areas, but this is generally very costly to implement and may not be a sustainable long-term solution for most ASC practices.
Q: Are there specific regulatory or payer policies you believe should be revised to better support this shift?
NK: One of the biggest obstacles to physicians participating in ASCs more actively historically has been Stark law. While Stark law has been beneficial in many ways in preserving the sanctity of the physician-patient relationship, it may be useful in the future to revisit portions of the law to better support physician involvement in ASCs. Given that the GI industry – especially with respect to CRC endoscopic screening programs – is shifting dramatically toward the ASC environment, having physician input and buy-in will be essential in forming lasting partnerships between health systems, payers, and patients across the GI care continuum.
