The past year has been challenging for ASCs.
Several centers temporarily closed or severely limited procedures during the early days of the pandemic and instituted new measures to safely resume elective procedures. In some cases, patients also lost insurance and were unable to return for their elective procedures. However, other centers saw a spike in demand for elective surgery as cases that had been postponed became urgent.
The future is bright for ASCs, according to five administrators who outlined changes in store for the industry.
Note: Responses are edited for clarity and length.
Amanda Gunthel. Administrator of Wilton (Conn.) Surgery Center: I think the current pandemic will significantly influence the next one to three years in the ASC industry. High community prevalence of COVID-19 may continue to mean volatility for ASCs in significantly impacted communities, but ultimately, I believe it will aid in supporting industry growth opportunities via the migration of cases from a hospital, or HOPD setting, to an ASC. The pandemic emphasizes the need for outpatient care to be available outside of our hospitals, and the economic impact commands patient access to high quality, lower cost providers. In addition, regulatory guidance issued during the pandemic, along with CMS changes to approved procedure codes in recent years, continue to pave the way for higher acuity surgery in the ASC.
Matthew Ewasko. Administrator of Physicians Alliance Surgery Center (Cape Girardeau, Mo.): Over the next few years I can see the ASC industry becoming more streamlined and more efficient. ASCs are already known for greater efficiency when compared to hospital outpatient departments, but they are also able to adapt to changes with greater ease due to their smaller size. I believe this will allow the industry to seek and adapt available tools and technology that will improve the overall patient and customer experience. The industry is already seeing a push from CMS and the large commercial payers to move procedures from the hospital setting to ASCs. With this push, ASCs need to ensure that their infrastructure in regards to staffing and technology is ready to handle the increase in case volume. I am confident that our industry can make this happen, and we will continue to provide excellent care before, during, and after the procedure.
Lawrence Parrish. Administrator of Illinois Sports Medicine & Orthopedic Surgery Center (Morton Grove): During the next one to three years, we can expect an accelerated migration of clinically appropriate cases from hospitals to ASCs, and the adoption of technologies that will help to make this possible. This includes a growing acceptance of generic implants and a decline in the reliance on sales reps to support cases to further reduce costs. In addition, we expect to continue experiencing periodic increases in vendor pricing, particularly with more costly branded implants, and more aggressive contracting by payers that will lower per case reimbursement. We can also expect to see an incremental growth in bundled payments. All of these developments will necessitate that ASC leadership find innovative ways of enhancing operational efficiencies and to seek opportunities for improving economies of scale.
Suzi Cunningham. Administrator of Advanced Ambulatory Surgery Center (Redlands, Calif.): I would expect the continued migration of inpatient cases to outpatient. Spine and joints are already proving this can be done, both safely and with better outcomes. What I would like to see is the restrictions eased on length of stay in an ASC. Right now, the 23 hour, 59 minute limitation eliminates a wide range of cases that can easily be done in an outpatient stay, with a successful recovery and discharge within 1.2 to 1.5 days. Our center is prepared for this migration, if the needle moves in a positive direction.
Last year, we added on to our center and built four extended recovery suites that mirror a hospital suite. This allows our spine and joint patients the comfort and privacy to recover from their surgery, allows for a family member to stay with them and have the benefit of being coached one-on-one by one of our experienced spine and joint nurses, so they know how to care for their family member upon discharge. ASCs can also do this much more economically than a hospital, so the patients and the health plans realize greater savings.
Jessica Huckins. Administrator of Northeast Wyoming Surgery Center (Gillette): I am a new ASC administrator. I have spent 17 years on the hospital side, and in light of COVID-19 I'm seeing the ASC utilized a lot more. It seems both surgeons and patients are more comfortable going where the patient isn't going to be possibly exposed to someone admitted on the floor. I do see that trend continuing as more patients are able to have their cases in the ASC versus the hospital outpatient department.
Our center is owned by an orthopedic group, and as soon as elective cases started up again last year, we saw a large increase in case volume and have sustained that since May of 2020. There have been nonsurgeon owners coming to the center as well. The orthopedic group purchased the surgery center in 2019, and there was a complete changeover of administration and staff. From 2019 to 2020, our case volume doubled.