Question: Do you see payers pushing procedures to the ASC setting or away from the ASC setting?
Editor’s note: These responses were edited lightly for brevity and clarity.
Paula Autry. CEO of Leadership DNAmics: I see payers pushing procedures to ACS settings when it is as effective as inpatient settings. In addition, providing procedures on an outpatient and/or short-term hospital stay basis encourages patients to recover in a home or rehab setting, allowing them to be with family and/or an environment focused on recovery to reasonable self sufficiency.
Stephanie Conquest. Administrator of Vanderbilt Surgery Center Cool Springs (Franklin, Tenn.): I see payers pushing procedures to the ASC setting due to the value and quality care ASCs offer.
Craig Sarine. Former CEO of University Surgical Associates (Chattanooga, Tenn.): In our practice, we have definitely experienced efforts by insurers to push cases to ASCs. However, in our market, the majority of ASCs are single-specialty facilities (orthopedic, gastroenterology, ophthalmology) — although that is in the process of changing. As such, we have very limited options, which the payers generally accept and clear the cases for hospital-based facilities. Definitely the push is toward ASCs, though, rather than the reverse.
Marietha Silvers, RN. Administrator of the Surgery Center of Cleveland (Tenn.): Commercial will be pushing more to the ASC in an effort to reduce costs, but not necessarily at a benefit to the ASCs if declining reimbursements are not addressed.
Matthew Solis. Director of Downtown Surgery Center (Orlando, Fla.): I still see payers moving cases to ASCs. They are saving money by sending them to our facilities. It would be nice for CMS to follow suit with the procedures they moved back onto the hospital-only list.
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