In the ASC industry's 50th year, consumerism, consolidation, regulatory changes, and new technologies are top-of-mind trends for ASC leaders.
To commemorate the 50-year milestone, Becker's ASC Review asked industry leaders to reflect on how ASCs have evolved, predict what the future holds and share highlights from their careers. This is the third installment of the series.
Question: Will ASCs remain important players in the healthcare market?
Note: Responses were lightly edited for style and clarity.
Nicholas Grosso, MD. President and orthopedic surgeon at The Centers for Advanced Orthopaedics (Bethesda, Md.): I predict that ASCs' importance in the healthcare community will dramatically increase over the coming years. Surgeries that are already routinely done in the outpatient setting, such as total joint replacement, lumbar laminectomy and spinal fusion surgery, will gain even more prominence in the outpatient setting.
Cheryl Garmon, DNP, RN. Director of Heaton Laser & Surgery Center (Tyler, Texas): ASCs will definitely remain important players in the overall healthcare market. There is unquestionably a place for safe, efficient, economical and quality care in the ASC setting. I anticipate growth in this area as technology and artificial intelligence increase and help to integrate primary providers, diagnostics and clinical interventions, which will help to treat and maintain the health of populations of people.
Yousif A-Rahim, MD, PhD. Chief medical officer of Covenant Physician Partners (Nashville, Tenn.): Yes. ASCs offer convenient and lower-cost alternatives to hospitals. Drivers for revenue growth are lower outpatient surgery costs in ASCs compared to other settings, improved safety driven by technological advancements, and the aging U.S. population. While reimbursement continues to be lower in ASCs compared to HOPDs, ASCs are able to drive profits through efficiency. For instance, lower OR turnover time and increasing patient volumes generate greater revenues. The revenue coupled with lower operating expenses produces attractive margins. In 2018, the average ASC operating expenses were 67 percent of net revenue; in hospital outpatient departments, this figure was 97 percent. Quality is also an important factor, as ASCs see lower infection and overall complication rates compared with hospitals.
Vincent Laudone, MD. Chief of surgery at Memorial Sloan Kettering Cancer Center's Josie Robertson Surgery Center (New York City): ASCs will continue to grow as improvements in surgical and anesthetic techniques expand the type of surgery that can be performed in an ambulatory setting.
Scott Jackson. Senior director of Henry Schein Medical's ASC business: ASCs will continue to play an integral role in the effort to control healthcare spending, while at the same time staying focused on outcomes. Ownership models will evolve, but the high physician ownership factor will likely remain, which in the end is a good thing.
ASCs will be handling more complex procedures, which in turn will present opportunities for growth. This dynamic, however, will create challenges as to how ASCs manage their staffing needs, supply expenses, and compliance requirements that come along with such complex procedures. These complex procedures tend to be more device-intensive, so ASCs will need to become more focused on containing their device expense line, as well as managing different levels of staffing requirements.
Michael Roub. Managing partner of Inflection 360: ASCs will definitely have a place in the healthcare market for years to come. With additional specialties like dental/oral surgery increasingly looking to have an ASC presence, there will be increasing ASC utilization to further enhance profitability. Hospitals can continue to focus on larger cases and patients in need of extended recovery where insurance companies pay a premium on facility fees. This will lead to increasing use of freestanding ASCs and office-based settings.
John Beck, chief solutions officer for NextGen Healthcare: Most importantly, in an age of consumerism among patients, ASCs present a more convenient and affordable option versus the hospital. For the surgeon, the ASC often has purpose-built surgical suites and is fully staffed by an operative suite of support staff specific to that specialty.
ASCs offer a more relaxed environment for patients and their families while providing high-quality care and better outcomes. ASCs are gaining appeal with providers again as the complexity of cases has increased in recent years. This evolution will continue as payers adjust contracts and consumers continue to demand high-quality, convenient care.
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