The midterm elections have revived talk in Washington of another push toward “Medicare for All,” but Dan Tasset, CEO of Leawood, Kan.-based NueHealth, predicts a different future for healthcare in the U.S.
Mr. Tasset, who founded the ASC company in 1997 and returned as CEO in July, has spent a lot of time on Capitol Hill. What he hears from lawmakers points to something other than a single national plan.
“I’m pretty confident in this following statement, and you can start seeing it now on both sides of the aisle,” Mr. Tasset told Becker’s. “I don’t think it’s a Medicare for All system. I think it’s a two-tiered system.”
His forecast starts with spending. Mr. Tasset cited research that healthcare is on pace to exceed 20% of U.S. gross domestic product by 2034, a threshold he believes regulators and policymakers can already see coming.
“So I think our regulators, policymakers know that and understand that, and they know that they’ve got to get out ahead of this,” he said.
Employers are feeling the same pressure. Healthcare is a growing expense on their income statements, and Mr. Tasset said they are wising up, too. He expects the industry’s long run of spending growth to end within five years.
“I think within the next few years, and certainly in the next five years, healthcare is no longer going to see this growth,” he said. “It’s going to be a zero-sum game.”
That pressure, in his view, won’t produce a single-payer system. Instead, he expects the roughly 150 million Americans who get insurance through their employers to be able to keep it, while anyone — including those without job-based coverage — gains the option to enroll in Medicare.
It is less Medicare for All, he said, than Medicare for anybody who wants it. He compared the model to the United Kingdom, where most residents rely on the National Health Service while a smaller share carry private insurance.
He argues the forecast follows from how the system protects itself. A full overhaul, like a full shift to value-based care, would require the industry’s biggest players to give something up.
“Here’s the punchline,” he said. “Why is that? Because right now, all of the incumbents, the status quo, that are part of our healthcare delivery system, are all trying to preserve their economics, which means a true transition or a significant transition to value-based care faces way more barriers than it does true proponents.”
For ASCs, the zero-sum math is already showing up in CMS payment policy. Mr. Tasset pointed to recent changes that gave the facility, or technical, side of ASC payment a lift while cutting the professional side paid to physicians. If total spending stops growing, those two pots will increasingly compete, and he argues surgeons are on the losing end.
Surgeons influence whether a procedure happens, where it happens and when, he said, which means they shape the cost, quality and outcomes of the entire episode. Yet as they have become faster and more efficient at performing total joint replacements in ASCs, their Medicare pay has fallen.
“So now they’re penalizing them for getting better and better at what they do,” Mr. Tasset said. “The only way to combat that is for a surgeon to be at the top of the food chain in episodic bundle arrangements.”
He is pushing CMS to add a voluntary fourth track to its three-track Transforming Episode Accountability Model that would let physicians convene Medicare total joint bundles, rather than leaving the mandatory model to hospitals.
As payers and employers look for ways to hold spending flat, Mr. Tasset believes the surgery centers that come out ahead will look different from today’s.
“The ASC of the future, the next generation, is going to be distinguished by their ability to integrate care, technology, and data, and have very sophisticated contracting capabilities,” he said.
In practice, that means contracting directly with employers, aligning with physicians and guaranteeing measurable clinical outcomes, whether centers choose to do so or are eventually forced to.
“I think those are the ASCs that are going to be best positioned where healthcare is going,” Mr. Tasset said.
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.
