Hospital employment of surgeons, reimbursement and the healthcare regulatory environment are among the most challenging issues for ambulatory surgery center owners and operators today.
"Healthcare currently is an unpredictable environment and expectations are continuously changing," says Gary Richberg, administrator of Pacific Rim Outpatient Surgery Center in Bellingham, Wash. "These continuous changes are making an ASC administrator’s job more challenging."
The changes in healthcare have been accelerated with the passage of the 2010 Affordable Care Act, aka. Obamacare, the expansion of Medicaid programs, an economy that is improving at a slower than normal rate, and stagnant increases in wages.
The country is still divided on the pros and cons of the ACA, some in congress still continue to seek repeal, while others seek to improve the law going forward. At this point the ACA is here to stay.
"The next presidential election may affect healthcare reform again," says Mr. Richberg. "There could be more regulatory changes, and those changes could be pro- or anti-ASC." If there is a repeal of the ACA, what is that product(s) going to look like and what is the role of ambulatory surgery center play in those changes.
Here are a few key notes on overcoming a few of the top challenges for ASCs today:
1. Reimbursement is in flux for many surgical specialties; however ASCs can lower their risks by focusing on operational efficiencies and diversifying more specialties or surgical procedures in their facilities. Mr. Richberg is mindful of profitable cases for his centers and strives to make sure those cases remain viable going forward.
2. High deductible health plans, commonly chosen in the health insurance exchange plans, are an issue. Especially when patients are responsible for a larger portion of the cost and facilities must collect deductibles and co-insurances upfront to maintain their profitability and reduce their bad debt.
"We always attempt to collect the deductible upfront," says Mr. Richberg. "Some ASCs use CareCredit or other payment plans to work with the patient to ensure their portion is paid if the patient is unable to pay their full cost share."
3. Consolidation in the industry also means that when more surgeons are employed by hospital systems fewer are available to perform cases at independently-owned ASCs. Primary care physicians are also joining hospitals, which could dry-up referral sources. "Consolidation has the potential to decrease cases to the ASC in some markets where hospitals also have outpatient departments," says Mr. Richberg.
4. ASC owners and operators have a great story to tell about their efficiency and cost-effectiveness. This story should be shared with surgeons as well as patients. "ASCs have to be more efficient than HOPDs and stress those efficiencies to other providers," says Mr. Richberg. "ASCs should be the standard of care across the patient spectrum for cost effective ambulatory surgical care.
5. The best way to prepare for an uncertain future is to remain educated on the changes in healthcare. "It's extremely important for ASC owners and operators to participate in state or national associations," says Mr. Richberg. "They need to understand how others in our industry are dealing with the changes in healthcare and preparing for the future in ambulatory surgery care.