The COVID-19 pandemic has brought on many changes to the ASC industry, including new service offerings and shifts in competition between hospitals and surgery centers, leading facilities to adapt in order to continue offering patients quality care.
ASC administrators were asked to describe their current overall outlook on the industry. Twelve administrators summarized the current ASC landscape, its challenges and what they see as opportunities for growth. Here are their responses:
Anna Weaver. Brunswick Surgery Center (Leland, N.C.): An ever-changing reimbursement landscape will continue to drive business to the ASCs. Medicare is removing several [inpatient/hospital outpatient department] CPT codes and adding them to the covered CPT codes allowed in the ambulatory setting. Commercial payers are looking for the most cost-effective location for their patients as well. I see a bright future and increased volumes for ambulatory surgery centers.
Christina Holloway. ASC Bala Cynwyd (Pa.): ASCs are finding strategic avenues of providing high-quality patient care in ways that allow patients convenience and cost-effective options for the most successful outcomes. Opportunities to heal at home whenever possible is a bonus in the current social climate.
Kevin Curtis. AZ Heart & Vascular Clinic (Glendale, Ariz.): Every major healthcare specialty from ortho [to] cardiac to urology and GI will impact how consumers choose care and how negative the impact will be to hospitals … I mean in a very big way!
David Scozzafava. Carillon Surgery Center (St. Petersburg, Fla.): We are seeing more complicated procedures moving toward the ASCs because they are more efficient and much less costly than in a hospital setting.
Andrew Lovewell. The Surgical Center at Columbia (Mo.) Orthopaedic Group: In 2019, 17.7 percent of the GDP was spent on healthcare. Of that spend, a large portion is attributed to surgical care. In a traditional sense, ASCs receive a smaller reimbursement for the same service that can be performed at an HOPD. However, the site of service differential is narrowing greatly. With a proposal to eliminate the inpatient-only list and allow more procedures to become available for ASCs to perform them, I foresee a bright future in the ASC space. I'd fully expect for the continuing trend of acquisitions and mergers to continue.
Higher-complexity cases such as total joints, cardiac and bariatric are three service lines that I fully expect to grow exponentially in the ASC world. ASCs today provide a tremendous upside to both patients and physicians. With a low cost [and] convenient healthcare setting, the value delivered to patients is incredible. Ultimately, I believe we will continue to see a migration of cases into the ASC arena.
Angela Laux. Advanced Spine Center of Wisconsin (Neenah): One word I would use to describe the ASC industry right now is "opportunity." I say this due to the fact that patients and insurance companies are increasingly seeing the value in ASCs related to cost savings, quality, customer satisfaction and accessibility. The addition of multiple spine codes by CMS to the allowed list also gives us the opportunity to expand our services.
Alfonso Del Granado. Covenant High Plains Surgery Center (Lubbock, Texas): We're feeling bullish because, first, the same factors that were driving cases from the hospital to the ASC before COVID are still present, and second, because COVID itself served to highlight the value of ASCs as a safe alternative treatment facility for nonemergency cases. Once testing kits and [personal protective equipment] became widely available, we were able to perform necessary procedures that could not be done at the hospital because of their need to reserve space for potential surges in COVID infections. We worked hand in hand with our hospital partner to ensure that patient needs were safely met without impacting capacity. The lessons from this crisis have been noted by many of the physicians in our community, and we have seen an increase in members and utilization rates. As their practice volumes return to normal, we are seeing more and more cases coming our way.
Cherilyn Smith. St. Johns Surgery Center (Fort Myers, Fla.): The ASC realm has undergone rapid changes, continuously shifting strategies as a chameleon changes colors to remain relevant in an often volatile industry. The true value of the outpatient setting is quickly being realized not only by providers, but by patients and insurance carriers as well, and management models in all forms seem to be taking notice. There continues to be a strong growth in the direction of shared and corporate ownership while solo physician-owned centers are sadly becoming more like the endangered species of the surgical kingdom. The latest opportunists that seem to be sinking their grip into these mergers and acquisitions are the private equity groups, who often have more cash for capital than common sense when it comes to providing good-quality patient care. It's interesting to see the transformation of patient-centered care and physician ownership as surgeons have historically broken from their hospital-only strongholds to fund their own centers and are now rejoining the shared management model, including, yet again, the hospitals.
When the focus is taken off of the patient and placed on the dollar, the foundations will certainly fracture. Most surgeons, while they may relish a handsome profit, do tend to take greater heart in devoting themselves to superior post-operative outcomes and happy patients. They say history is doomed to repeat itself. Surgeons were trapped in hospitals, because, for many, this was their only option. After breaking free and finding their independence, what drove them back into the shared ownership models? Perhaps poor management and lack of mentoring for the day-to-day operations could have been a factor. Many of these administrators are thrown into these positions truly out of convenience with little to no training or mentoring. It will be intriguing to see if surgeons will once again attempt to break away from those obligatory shared profits and pursue the dream of becoming their own boss once more, especially for the sake of the patient.
Donald Lenz. Eye Surgery Center of New Albany (Ind.): Following years of proving the value of ASCs in regard to efficiency, cost savings, safety and other quality metrics, ASCs stepped up to help in the national response to the pandemic emergency. Now the major payers, government agencies and employers have finally been able to see the totality of the value provided by ASCs.
The ASC industry started as a means for surgery specialists to secure [operating room] time without worrying about running over scheduled time or being "bumped" by surgeons whose specialties were more prone to emergencies and/or more lucrative to the hospitals. These visionaries saw the opportunity to have more input into how their patients received their care and a return on their investments. Over time as the industry developed, additional surgeons wanted to secure time and shares in the ASCs, leading to additional procedures being performed and an increase in demand. The ASC industry has continued to grow and transform itself until we have reached the current state.
Marcy Delvecchio. Central Ohio Surgical Institute (New Albany): [The future of the industry] is interesting. There will be a lot of changes, challenges and opportunities ahead for the ASC industry. Capitalizing on the opportunities will be key.
Matthew Ewasko. Physicians Alliance Surgery Center (Cape Girardeau , Mo.): I am very confident the ASC industry is poised for extreme growth and prosperity in the coming years. We have seen a migration of more and more cases moving from the HOPD setting to the ASCs, and there is no sign of this stopping in the near future. I believe this trend will continue as ASCs prove to be safe and profitable venues for all types of surgical cases. These facilities not only provide benefits to the surgeons, but more importantly, provide a benefit to the patients with lower cost and equal, if not better, outcomes.
Becky Ziegler-Otis. Ambulatory Surgical Center of Stevens Point (Wis.): The one word I would use to describe the outlook on the ASC industry right now is "dynamic." I chose this word because I believe the ASC space is constantly changing and there is a lot going on. Consider the mergers, acquisitions, regulatory changes, and pandemic implications all happening at the same time. Just as you move forward in direction, you need to be prepared to shift priorities and move in another direction or shift focus to keep up with the everchanging landscape.
Nathan Garner. Fort Sutter Surgery Center (Sacramento, Calif.): [I'm] optimistic. We are on the winning side of healthcare and there are still huge opportunities for ASCs to grow and expand in the current healthcare environment. Due to our ability as ASCs to consistently meet the quadruple aim in healthcare, we have seen more and more procedures added to the CMS approved list each year. Payers are pressuring providers and even vendors to move procedures typically performed in the hospitals into the outpatient space. Current areas of continued expansion and excitement are in total joints, minimally invasive spine, cardiology, and robotics. I am optimistic that as long as we continue to provide superior clinical outcomes, lower costs, and a positive experience for our patients and physicians, this positive trend of movement toward our ASCs will continue.