Should commercial payers launch ASC steerage programs? One administrator says yes

Patsy Newitt - Print  |

For Andrew Lovewell, the success of the ASC industry hinges on presurgery patient optimization and knowing which cases to take on. 

Mr. Lovewell is the administrator for the Surgical Center at Columbia (Mo.) Orthopaedic Group, one of Newsweek's Top 15 ASCs of 2021. He spoke with Becker's ASC Review on his outlook for the ASC industry. 

Question: What are your bold predictions for the ASC industry in the next five years? 

Andrew Lovewell: I think there is a gambit of possible predictions that could ring true in the ASC industry. A large majority of them revolve around the continued transition of CMS-approved procedures to the outpatient/ASC space. I think the more important thing to keep in mind with those procedures is that not everyone is going to be a candidate for surgery at an ASC. Don’t get me wrong, I am bullish on the future of ASCs! However, there are patients that simply can’t have surgery at an ASC due to other risk factors.

A truly bold thing that could happen would be that the commercial insurance payers come out and actually launch steerage programs to centers of excellence across the nation. This can’t be a race to the bottom though. It has to be a focus on quality work with possibly a tiered approach for outcomes. For years, ASCs have been doing total joint and spine cases but haven’t been as handsomely rewarded as they need to be.

The future for the ASC world is bright, but there will be a need for ASCs and physicians to collaborate and establish pre-surgical protocols to optimize surgical outcomes for patients. Optimization isn’t sending your patients to a primary care physician or internist to be cleared for a surgery, it’s truly maximizing the upside of the procedure being performed at an ASC for that unique patient. If this is done, physicians will be able to do more cases in their physician-owned ASCs, patients will have a much better outcome and the impact on the economy will be even greater if we can optimize the patients prior to surgery ever happening.   

Copyright © 2021 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.