Hospitals and health systems across the country are at an inflection point in their relationship with ASCs.
While some leaders still view the migration of cases to ASCs as a threat to revenue, others are beginning to see it as a powerful opportunity to expand access, reduce costs and strengthen the overall care ecosystem.
Bernadette Purser, senior administrator of ambulatory surgery at Richmond, Va.-based VCU Health, told Becker’s that many hospitals are still hesitant to lean into the ASC model because of fears over losing reimbursements.
“There’s still a thought process in some hospitals about not wanting to lose reimbursements,” she said. “That’s one reason there’s sometimes a slow migration to the ASC space.”
Janet Carlson, executive director of Louisville, Ky.-based Commonwealth Pain & Spine, echoed that sentiment.
“Hospitals are resisting the migration of higher acuity cases to ASCs, even though we perform them successfully with great outcomes at much lesser cost to the payer and patient,” she told Becker’s. “There’s been a successful migration of orthopedic total joints to the ASC space, which represented a huge loss of revenue for hospital systems. Now, with spine, cardiovascular and vascular procedures — other high-acuity, high-pain procedures — health systems are making life more difficult for those providers who try to migrate them to the ASC setting.”
Instead of viewing ASCs as a financial drain, both leaders say hospitals should see them as an essential part of a value-based growth strategy. Shifting cases to lower-cost, high-quality outpatient settings can optimize hospital capacity and create new efficiencies across the system.
Ms. Purser told Becker’s that ASCs should be viewed as “using a lower-cost platform.” Failing to make that shift can lead to major inefficiencies.
“If you don’t migrate those cases, you start to find a bottleneck with cases being done in the hospital that are ASC-appropriate,” Ms. Purser said. “That clogs everything up. When you move them out, you make more space for patients who need to get in sooner — cancer patients, higher-acuity patients. You’re not tying up precious resources and space.”
Ms. Carlson agreed. When employed physicians move cases to an ASC, she said, “they create more inpatient OR time for higher acuity patients. You’re optimizing the entire system. It’s a win for everyone.”
At VCU Health, it took time to change the mindset, but collaboration and data made the difference.
“We had to come together as a group. Sometimes ASCs end up on an island, but when you are a part of a university-based health system and partner with folks in the hospital, you see how it all works together within the same ecosystem,” she said. “When you start to see that needle move, others see it too, and you build momentum — like a snowball. Then you’re really maximizing capacity and resources on both sides. It takes time and repetition, but once it catches, it’s powerful.”
Data was critical in demonstrating the value of ASCs, she added, including metrics on ASC volume, outpatient cases still being performed in hospitals, turnover times, utilization rates and patient experience.
For hospitals still hesitant to engage, Ms. Carlson recommends open communication and partnership.
“Some forward-thinking health systems are entering joint venture ASC agreements,” she said. “If they’re smart, they’ll allow physicians to share opportunities. For employed physicians, if success is measured through [relative value units], there should be an RVU model that rewards using the lower-cost site of service.”
Both leaders remain optimistic about the direction of the industry.
“Seeing health systems embrace ASCs and recognize their impact on the overall ecosystem is exciting,” Ms. Purser said.
“Resistance is futile,” Ms. Carlson added. “It’s going to happen with or without their collaboration. ASCs are an elegant solution, especially in today’s healthcare climate. Hospitals can still live their mission, vision and values, take care of covered lives, communities and the clinicians who work in ASCs.”
