ASC administrators and physicians say the biggest obstacle facing the sector is a reimbursement structure that has not kept pace with rising costs or the expanding role of outpatient surgery.
From fee schedule disparities to outdated anesthesia payment models, four ASC leaders told Becker’s what they would change first.
Editor’s note: Responses have been edited lightly for clarity and length.
Question: If you could change one thing about how ASCs are regulated or reimbursed, what would it be?
Suzi Cunningham. Administrator of Advanced Ambulatory Surgery Center (Redlands, Calif.): If I could change one thing about how ASCs are reimbursed, it would be to align the ASC fee schedule more closely with the hospital outpatient department fee schedule. While we perform the same procedures with equal or better quality and efficiency, the reimbursement doesn’t align.
And, unlike hospitals, we lack the purchasing power to negotiate favorable pricing for implants, devices, pharmaceuticals and surgical supplies. As a result, we pay significantly higher costs for the same products yet are reimbursed at substantially lower rates than HOPDs. This imbalance creates a widening financial gap that is making it increasingly difficult for centers like ours to survive.
Adding to this issue are inflationary pressures across labor, supplies and operational costs; staffing shortages have driven up wages and benefits. At the same time, reimbursement updates have not kept up with these rising costs, effectively eroding already thin margins.
Bruce Feldman. Former Administrator of Eastern Orange Ambulatory Surgery Center and Founder of an ASC Consulting Firm (Cornwall, N.Y.): The biggest change I’d make is improving reimbursement. Right now, ASCs are still reimbursed at a considerably lower rate than hospital outpatient departments, and that needs to change. At a minimum, reimbursement should be comparable to what hospitals are receiving.
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia Consultants (Los Angeles): ASC reimbursement hasn’t kept pace with how anesthesia is actually delivered today. Historically anesthesia functioned as a variable cost because groups were paid per case and absorbed inefficiencies between procedures. That model has largely disappeared. Due to workforce pressures and recruiting realities, anesthesia coverage in many centers now functions more like fixed staffing infrastructure, similar to nursing or sterile processing. However ASC payment models still tend to treat anesthesia as a per-case expense. As outpatient surgery expands and patient complexity increases, reimbursement structures will need to evolve to support stable anesthesia coverage.
Lauren Phillips. Administrator of The Cardiac & Vascular Institute Ambulatory Surgery Center (Gainesville, Fla.): If I could change one aspect of how ASCs are regulated, it would be to develop more specialized regulatory standards for cardiac and vascular-focused ASCs. This is an emerging specialty within the ASC setting and is expected to continue growing as more procedures safely transition from hospital environments to outpatient facilities.
Cardiac and vascular ASCs operate in a cath lab-based environment, which differs in several ways from the traditional operating room model used in many surgery centers. The equipment, procedural workflow, staffing models, and emergency preparedness considerations often more closely resemble a hospital cardiac catheterization lab than a typical surgical suite.
Creating regulatory standards specifically designed for cardiac and vascular ASC cath labs could help ensure that surveys are more relevant to the services being provided. Tailored standards would likely make the survey process clearer and more efficient for both surveyors and administrators, while still maintaining high levels of patient safety and quality of care.
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