Twenty ASC owners, administrators and operators share one bold prediction about new specialties and procedures, mergers and acquisitions, and overall outlook for the ASC industry.
David Christensen, MD. Sawtooth Surgery Center (Twin Falls, Idaho): We have seen the development of multimodal pain management programs and minimally invasive access techniques. Couple these with the need to control healthcare spending nationally and CMS considerations for expansion of the list of procedures to be taken off of the inpatient only list. I see these factors coming together to significantly increase the ASC's market share in operative treatment across many specialties. ASCs could become the primary option for people to consider for operative care of medical problems, with hospitals being reserved instead primarily for care of medically complicated and [intensive care unit] patients. Using the most appropriate medical level of care for each patient will see a large shift to the outpatient and ASC setting.
Todd Currier. Administrator of Northern Wyoming Surgical Center (Cody): I feel that collaborative and strategic relationships with hospitals and management company partners will be essential in the coming years. We are seeing a lot of mergers amongst physician groups and consolidation within medical communities. This strength will help the industry grow exponentially as the push for outpatient care continues to grow and be desired by patients and payers alike. Those ASCs that are able to develop and coordinate service lines will thrive into the future.
David Horace. Bel-Clair Surgical Center (Belleville, Ill.): Vascular surgeons, invasive cardiologists and interventional radiologists will all have ownership in ASC facilities and create a mass exodus from hospital employment. Low risk electrophysiology procedures will gain traction, and economics will dictate that procedures be performed in the most cost-effective setting given the patient-specific risk associated with any given procedure.
Mitchell Schwarzbach. Administrator of Grand Valley Surgical Center (Grand Junction, Colo.): We will be 3D printing implants for totals (knee/shoulder/hips) in the ORs. Picture a composite with the patients' stem cells included. The composite would break down and bone will grow and take its place over seven years.
Debbie Smith. Administrator of Heart of Texas Surgery Center (Woodway): I think that the ASCs will continue to take on more and more cardiac cases and the hospital-without-walls scenario will play out to our advantage. I believe that if CMS looks at the data from the COVID-19 time period where we were able to act as a hospital and perform the cases that were normally done in the cath lab and were equally paid as [a hospital outpatient department], they will see that the patients had better outcomes and it was less expensive to be done in the outpatient setting. There may be some negotiating of the rates between an HOPD and ASC reimbursement methodology. It should be interesting for sure!
Mike Piver. CEO of Alabama Orthopaedic Clinic (Mobile): I believe that due to the enhanced technology and improved anesthesia and pain protocols, more and more procedures will safely shift to the ASC environment. As a result of this shift, more and more self-insured and insurance carriers will look to ASCs to provide a high-quality patient experience at a less expensive cost than hospitals. I think that orthopedic and spine procedures will be the ones that will and are shifting quickly, as evidenced by the growing number of ASCs that are performing outpatient total joint replacements.
Ajay Kumar, MD. New Jersey Advanced Pain Management Center (Hackettstown): I think [the] ASC industry will consolidate, and operating efficiency will be important. Also, the next five years would be golden years for ASCs because of the COVID-19 impact. Physicians as well as patients would be more reluctant to go to the hospital.
Matthew Ewasko. Administrator of Physicians Alliance Surgery Center (Cape Girardeau, Mo.): I see the ASC industry becoming more streamlined and technologically advanced. ASCs are strategically positioned to make quicker transitions with updated technology than large OR departments within the hospital settings. The updates in technology will allow for billing departments to submit claims quicker and cleaner which will expedite the reimbursement process from all payer types. This will improve cash flow for the ASCs and also save time due to process improvements.
I can see more and more ASCs moving to EMR systems within this timeframe. A move like this can eliminate paper charts, free up much-needed storage space within the facility and improve collaboration between the facility and physician offices. A move to an EMR, or upgrade to other software programs, can also improve patient engagement and satisfaction since it will allow them to have increased insight into their bill and what options might be available to them. A satisfied patient is more likely to pay their claim on time and/or respond with any information that the facility might need.
Updates to the technology currently used with the OR suites themselves at the ASC will enable current procedures to be completed in less time, while also allowing surgeons to bring more complex procedures into the ASC and away from the hospital settings. The decrease in OR time will aid in staffing, while new cases can increase the bottom line of the ASC.
Those ASCs that are willing to commit to the advancements in technology will get ahead of the curve and see the benefits sooner than those who don't. If the past several months have taught us anything, it's that we need to rethink our entire process and find ways in which we can improve. Continuing to keep everything as-is will no longer work, and using the phrase "That's how we have always done it" will prevent the ASC from taking advantage of the growth opportunities that lie ahead.
Lew Little. CEO of Covenant Surgical Partners (Nashville, Tenn.): With CMS expanding the number of procedures that can be performed on an outpatient basis, you will continue to see good organic growth in the ASC platforms. Post pandemic, people will feel less comfortable going to hospitals for procedures. Payers will take a more active role in directing their patients to lower-cost sites of care, and the arbitrage between ASC and HOPD rates should tighten.
Bonnie Brady Lavoie, RN. Vice President of Operations at West Morris Surgery Center (Succasunna, N.J.): I believe the days of "Mom and Pop" freestanding ASCs are rapidly ending. It's becoming increasingly difficult to negotiate contracts and get best supply pricing without a hospital partner. Many hospitals are looking for efficient surgery centers, and it's a good marriage for both. During COVID-19 it became apparent we need each other.
Neal Maerki, RN, CASC. Administrator of Bend (Ore.) Surgery Center: I do see a push by large clinics with at-risk contracts to work in concert with ASCs to provide a lower-cost network than area hospitals, but you have to be careful it is not to the detriment of the ASC. The ASC also needs to be able to participate in the shared savings. Otherwise they are just saving the clinic and the insurance provider dollars.
Lori Tamburo Martini. Administrator of SOG Surgery Center (Tupelo, Miss.): I'm not certain this prediction is necessarily bold, as I'm sure it is the sentiment of many leaders in the ASC industry. There will be significant growth in the ASC space over the next five years. As surgeries continue to shift from inpatient-only status with CMS, ASCs will see a substantial increase in surgical volume. The cost savings for both Medicare and commercial payers is a factor, but in my experience, patients are also more educated and invested in the decisions surrounding their healthcare. I predict that the most substantial growth will be in spine and total joint procedures.
Tracy Hoeft-Hoffman, MSN, RN. Administrator of Heartland Surgery Center (Kearney, Neb.): [The] ASC industry will grow exponentially over the next five years. With the CMS inpatient-only list [potentially] going away over the next few years and the demographics of our populations changing, we are in a great position to perform more cases than we previously have. With more states allowing 23-hour stays in the ASC, we have an opportunity to perform procedures that require a longer recovery time. Spine, total joint replacements and vascular are certainly procedures that will be performed more and more in the ASC.
Payers and healthcare consumers are realizing they can reduce their costs by choosing to have outpatient surgeries performed in ASCs. Price transparency will play a role in ASC growth over the next five years. We list the price of our top 25 procedures on our website. With the opportunities for growth over the next five years, ASCs need to strategically plan for this: additional staff, capital expenses, supply costs, etc. Most importantly, we cannot forget that we are here for the patients. We need to continue to provide them with a calm environment, excellent care, and making them and their families feel comfortable while at your ASC.
Corey Roberts. CEO of Charlotte (N.C.) Surgery Center: My outlook for the ASC industry is very positive. First, the number of cases should increase as the baby boomer population increases in age and are in need of elective surgeries that we provide. Secondly, we are seeing a systematic shift in CMS and the increasing number of cases that are being moved to the ASC space (total joints, cardiovascular, etc.). Finally, through price transparency, quality reports and satisfaction ratings, patients are seeing the overall benefits of having their surgeries at an ASC.
ASCs will need to continue to concentrate on cost saving, quality at every step and treating our patients as if they were a family member. The five-year projection would be a doubling in the number of ASCs to serve the increase in demand.
Michael Sutton, DO. McLeod Health (Dillon, S.C.): Most work will be done in an office setting, from diagnostic arthroscopy to more minor surgical procedures — ganglion cysts, carpal tunnel, trigger finger, even minor arthroscopic knee surgery, simple meniscectomies and chondroplasties, maybe screw removal under local anesthetics as well.
Harish Gagneja, MD. Austin (Texas) Gastroenterology: ASCs will do even better than they are doing. We will do complex procedures such as Barrett's ablation, large polyp resection, endoscopic ultrasound, fine needle aspiration and possibly endoscopic retrograde cholangiopancreatography at ASCs as well. Insurance and Medicare will prefer ASCs [over] hospitals for endoscopic procedures. Artificial intelligence engines for Barrett's esophagus and colonoscopy will be common. There will be bariatric-specific ASCs.
Mihir Patel, MD. OrthoIndy (Indianapolis): Over the next five years, with the use of technology, data and preferences, ASCs will be able to deliver a complete episode of care across multiple specialties. Patients and their employers will think [of] ASCs first to get them back to doing what they enjoy. Advances in technology from procedural to post-care monitoring and rehabilitation will allow providers to deliver in an extremely safe, efficient environment. Monitoring real-time data will customize the episode of care to the level of the patient, even beyond the institution. With the ability to deliver the art of medicine in addition to the science, patients will choose providers in ASCs with superior outcomes from start to finish.
Chris McClellan, DO. University Orthopedics Center (Altoona, Pa.): My bold prediction is that at least 75 percent of total joints will be done as an outpatient from freestanding and hospital ASCs, saving millions for the healthcare system. More importantly, I feel that freestanding ASCs will make the biggest impact as it has the greatest effect on lowering costs of these procedures. The savings are real and indisputable from freestanding ASCs.
Vip Nanavati, MD. Humphrey Shoulder Clinic (Eagle, Idaho): I think it is inevitable that there will be an increase in the size and scope of ASC development, utilization and type of cases expansion. This trend was already happening pre-COVID. I believe COVID-19 has only accelerated the paradigm shift away from hospital-based surgeries to outpatient facilities. The healthcare sector has not been and is not immune to COVID-19 as a disruptor of industry.
Patient confidence in hospital-based care for elective outpatient surgeries has become less desirable with regards to patient preference if it is avoidable.
If we follow the principle that healthcare is becoming more patient-centric and consumer-driven, it follows that healthcare services will transform to meet consumer preference. The question at the heart of this change is, "What job does the surgical patient want done?" Certainly it's a successful surgery and a good outcome. If we dig deeper, though, there is the desire for ease of access, safety, lower cost and an emotional component of peace of mind; there exists now a fear (rational or not) of going home from the hospital setting with a disease — in this climate, COVID. Though the other more operational factors can be adapted to, the emotional component is much harder to reconcile.
As the number of independent and hospital-based ASCs grow, I suspect you will see increasing lobbying pressure on Capitol Hill and at a state legislature level for increased regulations and barriers to entry for new ASCs into the market. To me, we will see regulatory changes and the development of barriers to new entry that will be driven by the loss of revenues that hospital systems have experienced, and continue to experience, from this pandemic and from the irreversible trend of lucrative income generating high-volume surgical procedures leaving the hospital setting.
History tends to repeat itself. I liken the rise and fall of ASCs to the rise and fall of physician-owned hospitals in the previous decades.
Chris Dougherty, DO. Agility Center Orthopedics (Bentonville, Ark.): The ASC industry will lead the way in the implementation of block chain in the healthcare industry. We are actually on our way.
Lori Sylvester, MSN, RN. Administrator of Riverside Outpatient Surgery Center (Columbus, Ohio): As more surgeons get comfortable with pushing the envelop with what can be done at an ASC and as more insurance companies see this as a low cost alternative to care with high patient satisfaction, and decrease in infection rate, cases should increase at the ASCs with higher ASAs, utilization of blocks and increase use of the 23 hour hold. The hospitals will become more specialized in lines of service for medical care.