Value-based care contracts are already reshaping how some ASCs get paid, but physicians say most payer conversations still circle back to cost rather than outcomes.
At Becker’s 32nd Annual Business and Operations of ASCs conference in Chicago, three physicians discussed what’s working and what isn’t as ASCs take on more risk. The panel included Nina Pasqua, MD, a gastroenterologist and quality chair at The Oregon Clinic in Portland; Stefan Esper, MD, a cardiac anesthesiologist and director of the Center for Perioperative Care at UPMC in Pittsburgh; and Ali Ghassemi, MD, an orthopedic surgeon and faculty member at Thomas Jefferson University in Philadelphia.
Asked to rate how real value-based care is in ASCs today on a scale of 1 to 10, Dr. Pasqua gave it a 10. The Oregon Clinic’s three physician-owned GI ASCs hold contracts with CareOregon, the state’s Medicaid plan, tied to GI quality metrics such as adenoma detection rates and surveillance interval compliance. The group also has episode-of-care bundles with Regence BlueCross BlueShield.
Getting there took time. Dr. Pasqua said the group spent four years working with the payer’s value-based team before reaching an episode-of-care contract, and early talks struggled to align on which metrics mattered.
She also cautioned ASC leaders to watch how targets move year to year. Her group hit 94% on appropriate surveillance intervals, only to see the target raised to 96%.
“There is no evidence behind bringing appropriate surveillance interval from 94 to 96,” Dr. Pasqua said. “You have to be cautious with these and make sure that they’re based on evidence.”
Dr. Esper said the core question for any payer partnership is whether the payer will pay more for better outcomes, or whether every conversation ends in a lower rate. He estimated about 80% of payer discussions focus on cost.
“Everybody wants to talk about better outcomes, but they’re all really just concerned about the cost,” he said.
He also pointed to a structural gap: ASCs are paid for the day of the procedure, while CMS bundles hold hospitals accountable for readmissions and mortality over 90 days. He argued the surgical episode should be measured over months to years, with surgery serving as an entry point into population health.
Dr. Esper shared results from UPMC’s Center for Perioperative Care, which screens and optimizes patients before surgery. When the center began point-of-care A1C testing for patients over 40 years of age or with a BMI above 30, 157 of the first 303 patients tested had prediabetes or diabetes. In unpublished data from a manuscript recently submitted for publication, Dr. Esper said a comparison of 3,000 patients — 2,000 who went through the center and 1,000 who did not, with the same surgeries, surgeons and hospitals — showed lower 90-day readmission, 90-day mortality and one-year mortality, along with a 23% per-member-per-month cost reduction for the health plan over 12 months.
Dr. Ghassemi rated value-based care in orthopedics a 6 out of 10. ASCs have succeeded with knee replacements, he said, but have missed a large group of patients with moderate knee osteoarthritis who could benefit from joint preservation surgery. Instead, many of those patients cycle through repeated injections until they qualify for a replacement.
“If I am a payer, I like to pay less,” Dr. Ghassemi said. “We cannot expect the other side to pay more.”
He suggested a pilot collaboration among payers, ASC leaders and orthopedic surgeons to track outcomes and reimbursement over two years, including recovery and patient satisfaction a year after surgery.
On cost control, panelists said surgeons respond to data and to having a stake in the results. Dr. Pasqua said showing surgeons that peers achieve the same outcomes at a fraction of the cost, paired with shared savings, can change behavior. Dr. Esper said competition did the work when UPMC launched enhanced recovery pathways in 2014: once reluctant surgeons saw colleagues cut length of stay by three days, they wanted in.
“If the outcome is the same,” Dr. Esper said, “justify the value of why you’re using something more expensive.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
