Rita Numerof, PhD, is president of global healthcare consulting firm Numerof & Associates, which recently published its annual survey on the state of value-based adoption in the U.S.
Dr. Numerof discussed the findings and implications with Becker's ASC Review.
Note: Responses were lightly edited for style and clarity.
Question: Why do you think value-based care adoption has stalled?
Dr. Rita Numerof: Although almost all leaders agree that value-based care and population health management is the future, the majority hesitate to take the leap. That's not to say we haven't made any progress — some have shifted to payment arrangements that link costs to outcomes and increase their accountability. However, in looking at just how much they've invested in risk, the numbers are meager at best and indicate that most health systems are only experimenting. Simply put, their reluctance involves several issues [outlined here].
That said, I truly believe change is right around the corner. Growing public frustration over high medical bills, insurance premiums and drug costs can't be ignored indefinitely, and market/ value-based reforms are the best hope for change. Now, more than ever, the opportunity is ripe for health systems to fundamentally change their business models and gain a competitive advantage.
Q: What can ASCs do today to advance value-based care? What short-term and long-term strategies can they put in place?
RN: ASCs can accelerate the industry's adoption of value-based care by doing a couple things. In the short term, they can make sure that they have the latest tools and intelligence needed to deliver the highest-quality care at the lowest cost. If ASCs are up to date on cutting-edge, evidence-based surgical techniques and 21st-century technologies, they can deliver high-quality care at the outset and reduce expensive — for them and for their patients — complications and readmissions.
A long-term, ongoing objective ASCs can work on is developing relationships with larger health systems willing to refer patients with qualifying conditions to their centers. Many ASCs are now able to perform endoscopies, colonoscopies, cataract surgeries and a handful of other [procedures] in an outpatient setting. So, rather than have patients undergo these procedures in costly, often dangerous inpatient environments, hospitals can move patients to safer, more convenient and lower-cost ASCs that are just as, if not more than, capable of providing such services.
Hospitals were never meant to be destinations of choice, and outpatient settings like ASCs can keep patients out of the hospital, therefore furthering value-based care's mission of mitigating costs and increasing quality.
Q: How can value-based partnerships impact a surgery center's bottom line?
RN: We are seeing value-based care get more and more time in the spotlight. Currently, provider participation in payment models that take on risk and move patients away from fee-for-service are only voluntary. However, there is an understanding from CMS that mandatory models are needed, and those could be coming soon. In such models, provider reimbursement would depend upon their ability to produce positive patient outcomes. And if [providers] fail to do so, they — not CMS, an insurance provider or the patient — will have to foot the bill.
Ensuring hospitals and ASCs consistently deliver high-quality care will require a close look at their operations, and if improvements must be made, an accompanying cultural shift. Cultural change can take up substantial time and resources, which is why the hospitals and ASCs that take on risk before they're forced to do so will be the ones best prepared to handle this fundamental change to their business model, whenever it does become mandatory.
The ASCs that deliver low-cost, high-quality care will be financially rewarded for doing so. CMS will reimburse quality ASCs at a lower rate, and in providing thorough care right away, ASCs will expend less time and fewer resources on patients that have to be readmitted. Value-based care adds value for patients, but wise providers see the value in it for themselves, too.
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