As the migration of outpatient surgeries accelerates, some hospitals are showing resistance, particularly as higher-acuity procedures begin to shift to the ASC setting.
While this is not a universal stance across all health systems, some leaders believe the reluctance from certain hospitals is creating friction and stalling progress toward more efficient, cost-effective care.
Janet Carlson, executive director of Commonwealth Pain & Spine, joined Becker’s to discuss what this resistance looks like.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Have you experienced or observed any friction with hospitals amid the general outpatient migration, as hospitals look to protect revenue?
Janet Carlson: Absolutely. 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. 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.
I’ve even heard of hospitals silently punishing physicians by taking away personal block time. For example, where they used to have guaranteed block time, now it’s just a block for your whole practice, and you all have to figure it out internally. And then, when they are there, the constant frustration from physicians is that they book cases that must be done in the hospital, but they’re treated as lower priority than hospital-employed surgeons. They don’t get a flip room, and room turnover can take 45 minutes or more. The surgeon ends up sitting all day in the lounge twiddling their thumbs.
It happens all the time. It’s more about revenue loss than cost savings or providing a better, safer site of service. The majority of patients who pass my anesthesia selection criteria don’t need a hospital setting, where the risk of infection or other complications is higher. There is significant friction, and now hospitals are showing interest in getting into the ASC space because they realize they need to get on board or continue losing revenue.
Q: Have you seen any strategies to combat this friction?
JC: You really need open, clear communication and to know the stakeholders at the hospital. Some forward-thinking health systems are entering joint venture ASC agreements. If they’re smart, they’ll allow physicians to share opportunities. For employed physicians, if success is measured through RVUs, there should be an RVU model that rewards using the lower-cost site of service.
If you don’t adjust the RVU model, the surgeon moving a case to the ASC gets penalized — they miss bonuses or KPIs. You’ve got to find a way to offer ownership or a better reward structure for migrating those cases. When employed physicians move cases to an ASC, they create more inpatient OR time for higher acuity patients. You’re optimizing the entire system. It’s a win for everyone. It’s rare, but forward-thinking hospitals also recognize that their cash cow — hospital outpatient departments — will one day disappear. HOPDs are essentially ASCs reimbursed at hospital rates.
