CMS wants to send even more surgical volume ASCs’ way — and some leaders think their case lists are about to grow relatively quickly.
The agency proposed a rule July 2 that would revise Medicare payment rates for HOPDs and ASCs starting in 2027. The proposal would also continue to phase out the inpatient-only list and expand the ASC Covered Procedures List.
Two leaders recently joined Becker’s to share their thoughts on how the proposed rule could continue to shape outpatient migration.
Editor’s note: Responses have been lightly edited for clarity and length:
Question: With CMS continuing to phase out the inpatient-only list and expand the ASC Covered Procedures List, how much more surgical volume do you realistically expect to shift from hospitals to your ASC in 2027, and how can ASCs prepare for it?
David Carmichael. Administrator/CEO of Birmingham (Ala.) Obstetric Gynecology: Our practice does not currently own an ambulatory surgery center, although we are actively evaluating long-term opportunities as more gynecologic procedures become appropriate for outpatient settings.
For women’s health, I believe the larger impact will occur over the next five to 10 years rather than in 2027 alone. As minimally invasive gynecologic surgery continues to evolve, more hysterectomies, pelvic reconstructive procedures and other complex gynecologic surgeries can safely be performed outside the traditional inpatient hospital environment.
I do not expect a dramatic one-year shift in surgical volume, but I do expect this proposal to accelerate investment in physician-led outpatient surgery programs and partnerships between hospitals and independent physician groups.
One aspect that deserves attention is the continuing consolidation of physician practices. There are simply fewer independent OB-GYN groups today with enough surgical volume to justify developing an ASC or entering into a joint venture with a hospital. Many smaller independent groups are effectively left on the outside looking in. While my perspective is from women’s health, I believe this trend extends across multiple specialties. As physician consolidation continues, it may unintentionally reduce the number of independent groups able to take advantage of policies intended to expand outpatient surgical care.
For ASCs, success will depend less on adding operating rooms and more on building the infrastructure needed for higher-acuity patients, including anesthesia, recovery protocols, care coordination, quality reporting and data systems that demonstrate excellent outcomes.
Lauren Phillips. Director of Invasive Services at the Cardiac and Vascular Institute (Chiefland, Fla.): As surgery centers continue to advance and grow. I see this shift happening fairly quickly. Insurance companies are seeing the financial benefits of patients having their procedure done in the ASC setting and patients are also seeing the benefits and expert level of care that they can receive in the ASC setting. Being in a cardiology/peripheral-based ASC, our procedure list is continually expanding and I see this push only making that expansion continue and potentially at a more rapid pace. This is a great thing for ASCs and the patients that they serve.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
