10 key challenges & strategies for ASCs: Reimbursement, growth and owner-administrator relationships

Medline hosted an executive roundtable of ASC owners and administrators at the Becker's ASC 23rd Annual Meeting—The Business and Operations of ASCs on Oct. 28, 2016. The participants discussed the challenges their facing as well as strategies for success in the future.

1. The key challenges for reimbursement discussed at the event include increased expenses while reimbursement remains low. The physician fee schedule was one stressor, as ASC's are reimbursed on a different scale than hospital outpatient departments. CMS released the 2017 final rule on Nov. 1, 2016, increasing ASC reimbursement 1.9 percent.

2. The participants found orthopedics a good specialty as long as the center can control implants. Some of the centers were considering total joint replacements, but needed viable contracts from insurance companies to cover the costs at their centers. ASCs may also experience pressure from hospitals not to bring the large joint and spine cases into the ASC, which is an additional challenge.

3. When recruiting surgeons who are more familiar with the hospital setting, it takes time to transition into the ASC environment. It can be a challenge to bring in total joint replacement surgeons who have the hospital mindset, looking for a "doctor's lounge" or answering emails between cases.

4. Gaining an audience for payer contract negotiations was a challenge. The ASCs gathering data and sending it to the insurance companies accelerated their contract negotiations. Transfer rates, complication rates and infection rates are key to share with payers. Publishing data in peer review journals is also becoming a bigger trend to show Medicare and other payers ASCs can do big procedures safely and effectively.

5. Even ASCs that don't need physicians currently are recruiting to backfill space so the ASC will still be filled a few years down the road as physicians retire. The ASC owners and operators suggested bringing in new surgeons and specialties that fit with the current specialties at the center. Block scheduling and compressing the schedule opens up additional time for new cases.

One administrator discussed filling block time with her physicians and rearranged unused block time to reassign efficiently. Another administrator reported her ASC has a scheduling committee that consists of physicians, so any issues with scheduling or filling block time are discussed physician-to-physician.

There are markets where hospitals or corporations purchase physician practices and cost of care goes up. There were a few ASCs represented that reported reaching out to young physicians through a fellowship program and residency programs. Exposing the young physicians to the private practice setting can encourage them to remain independent; while many young surgeons seek employment after training it is still possible for physicians to forge a different path.

6. There were ASCs present that benefitted from hospital joint ventures, as the hospitals were eager to send low acuity cases to the ASC and open up their ORs to higher acuity cases. There were examples of ASC joint ventures where the hospital allowed physicians to go to the ASC because there wasn't enough space in the hospital for their cases.

7. At ASCs where physicians aren't owners, it can be challenging to motivate physicians to bring cases. At one center represented, the center staff members were directed to treat physicians as the customer. Another administrator changed the culture at her center after taking the helm to open a dialogue with physicians instead of always answering "no" to requests.

8. Administrators can build a relationship with physicians by going to board meetings and engaging them. There were a few centers that brought physician owners and their families together at informal gatherings, dinners and events at the center so everyone knows each other on a personal level outside of the office.

9. Communication with partners is important — one administrator sends out a weekly email on Fridays with important information and news for the week. The emails also show what the ASC operations deal with every day. Another administrator emails information monthly and if she doesn't get a response, she visits the physician personally and requires the physicians attend board meetings to receive distribution checks. A physician from another center is present every day of the week at the center and makes sure data about the center are transparent.

10. Driving case volume has been a challenge over the past few years, especially as referring physicians and independent specialists become employed at hospitals. There were a few other centers planning to add young physician owners and purchasing physician practices to add cases in the next year.

Additionally, one GI center allocated time to bring in cases from local prisons, as the federal prisons are looking for quality care at a low cost for prisoners. The physician reported the prison is among the best payers for the center.

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