Payer and employer pressure to lower healthcare costs is accelerating the shift of surgical procedures into ambulatory surgery centers, according to Jeffrey Flynn, COO of Gramercy Healthcare and president of the New York State Association of Ambulatory Surgery Centers.
Mr. Flynn shared his perspective during a live recording of the “Becker’s Healthcare Podcast” at the 31st Annual Business and Operations of ASCs conference in October, where he outlined how payer economics are reshaping site-of-care decisions across the healthcare system.
Rising healthcare costs remain the dominant force pushing procedures out of hospitals and into lower-cost outpatient settings, he said.
“I think cost is the biggest factor contributing to an unsustainable climate of healthcare cost in this country, and recognizing that the appropriate cost of service are not being followed,” Mr. Flynn said.
Payers and employers are increasingly steering care toward ASCs as technology enables more complex procedures to be performed safely outside the hospital.
“Insurers, payers, and employers are actually now demanding that they want to see, with newer technology, the higher acuity cases going into the lower cost settings, which are cost more efficient,” Mr. Flynn said.
Beyond cost, patient experience also reinforces payer interest in ambulatory settings where predictable scheduling and throughput can improve satisfaction. ASCs often provide better patient experience because it’s less chaotic than the hospital, serving fewer people and staffed for more one-on-one attention between patients and the surgical team.
As payer-driven site-of-care pressure increases, Mr. Flynn said ASCs should focus on absorbing more complex cases rather than worrying about lower-acuity procedures migrating to office-based settings. Cataracts are one example of procedures now being performed in office-based settings.
“Cataracts eventually will be, in the next two or three years, in the office-based setting,” he said. “I don’t think that’s a thing to be concerned about. I think we embrace the higher acuity procedures as we bring those to us.”
Technology investment is becoming unavoidable as payer economics intersect with surgeon expectations and case mix changes. Robotics, in particular, are increasingly influencing where surgeons choose to practice.
“From the situation of bringing and introducing robots into the, the ASC setting, we’re not going to have a choice in the future,” Mr. Flynn said. “The reality is, orthopedic surgeons and general surgeons coming out of training now are looking for that robot.”
Administrative automation also plays a role in payer-driven efficiency efforts, allowing ASCs to control costs while maintaining access.
“In a fairly busy center, patient confirmations take about four hours a day,” Mr. Flynn said. “If you can expand your bandwidth of that person’s doing something else, that could be huge for you.”
Health system partnerships are emerging as another response to payer economics, particularly as hospitals look to reserve inpatient capacity for the highest-acuity cases while maintaining access in the community.
“They can actually understand that they need to offload certain cases to have room to do the higher acuity cases in the hospital, and they’ve embraced that,” Mr. Flynn said, pointing to joint venture models in New York. “These centers have run efficiently, and they’ve actually gotten care access to patients.”
As payers continue to push care into lower-cost settings, workforce development remains a concern for sustaining ASC growth.
“We’re somewhat having a brain drain, so to speak, because nobody trains to come into our fields,” he said.
Despite those challenges, Mr. Flynn said payer-driven momentum favors continued expansion of ambulatory surgery centers.
“In the ASC community, this really is our time to further grow,” he said. “It is a very exciting time.”
