Healthcare, as an industry, is shaped by the convergence of a wide array of factors, including policy, labor and technology, to name a few.
As the industry grows, ASCs have gained prominence as a way to increase surgical volumes while cutting out inefficiencies, lowering costs and meeting community health needs while offering a more convenient and comfortable environment for patients.
However, the future growth and success of ASCs is still tied to support from lawmakers and well-informed healthcare professionals, Brett Maxfield, CRNA, president and CEO of Rigby, Idaho-based Maxfield Healthcare Solutions and president of the Idaho ASC Association, told Becker’s in a recent interview for Becker’s ASC Review podcast.
“I think a really important thing for people to understand is that healthcare is in need of disruptors right now,” Mr. Maxfield said. “The trend towards ASCs is, as long as it’s done the right way, definitely that potential disruptor.”
Mr. Maxfield recounted an experience speaking with state lawmakers about the difference in reimbursement rates between ASCs and HOPDs and realizing how little they understood about the difference in billing processes between the two outpatient settings.
“One of the specific examples we talked about is how in an ASC, a true ASC, your CPT code is kind of the ceiling,” he said. He laid out an example in which a procedure performed in an ASC is reimbursed $6,000 per its CPT code, which includes any facility fees, pay for staff or other costs, excluding an anesthesia professional fee.
“Versus in the hospital, [the CPT code] is kind of your floor instead of your ceiling,” Mr. Maxfield continued. “You start with that, then you get to charge for nursing fees, facility fees, medication administration fees … all kinds of stuff gets added on top. They had no idea why ASCs were cheaper.”
He said that as the conversation progressed, the lawmakers became more interested in the potential efficiency of higher ASC utilization.
“About 15 minutes into the conversation, one of the state senators says, ‘Hey, can we mandate that anything that can be done in an ASC is done in an ASC?’ And I kind of just looked at him and laughed,” Mr. Maxfield said. ‘I said ‘Hey, you’re the government, you can do whatever you want to do.’ So, theoretically, one 15-minute conversation with the right people within the government could have saved this particular state literally hundreds of millions of dollars in Medicaid fees, and could have generated additional revenue for these ASCs, all while saving taxpayers money, saving patients money and throwing things into a system that’s a little bit more efficient.”
Mr. Maxfield said that as an anesthesia professional, he has also witnessed the operating room inefficiencies that become common in hospital settings diminish in the ASC, where quick turnaround times and maximum OR efficiency are more embedded into the practice.
The implementation and scaling up of AI tools will continue to be a key element of OR optimization, as leaders will be able to more accurately collect and analyze data across surgeons and procedures within their facilities and identify areas for improvements.
“As we do that, as we become more efficient, it’ll have ripple effects, as long as the administration treats things ethically,” Mr. Maxfield said.
