Healthcare is barreling toward integration — 5 key thoughts on where ASCs fit

The best specialties and procedures for ambulatory surgery centers in the future will be the traditionally inpatient cases leaving the hospital for an outpatient setting. Orthopedic total joint replacements, spinal surgeries and bariatric surgery are a few examples. Minimally invasive procedures and advances in anesthesia and pain management allow physicians across the country to perform these cases in an ASC, and ASCs are waiting with open arms.

And some hospitals are happy for the extra operating room space as well.

"If you can unburden the hospital from something that's costly and bring it to an environment where it costs less, it's beneficial," says Fred Davis, MD, president and co-founder of ProCare Systems. "The diseases of the aging population will have a huge impact over the next several years; orthopedic and neuromuscular conditions are number one with heart disease and cancer care right behind."

The more progressive hospitals are joint venturing with physicians on ASCs and aligning with the outpatient providers in their communities to build larger perioperative surgical homes and campuses that could transform the healthcare experience. ASCs traditionally focused on just the surgical episode — physicians' offices coordinated pre- and postoperative care, and sent patients to separate providers for rehabilitation. But this is no longer acceptable in the age of integrated medicine.

"The bigger picture is how ASCs are going to fit into the transformation of the perioperative surgical home and systems of care covering the episode of care," says Dr. Davis. "How can ASCs best prepare themselves to integrate with the episodic and chronic care patients require?"

Partnerships are one solution.

ASCs are working with other independent providers in their area, including physical therapy, rehabilitation, home health services and surgical nursing facilities to create medical campuses or virtual complexes addressing the continuum of care. The medical home can help with pre-procedure counseling, weight loss and smoking cessation. They're also including non-traditional health services, such as nutritionists, psychological and behavioral care and fitness experts.

"This embeds the ASC in the healthcare system and makes them more indispensable," says Dr. Davis. "You need a strategic vision for how the system will work and the leadership to bring all the parties to the table. You have to have enough clout within all the organizations involved. You need a champion, but also the decision-maker must be high enough in the organization to make the collaborations happen."

The key elements for building a perioperative medical home include:

1. A strong leader with the right clinical skills and respect from their peers to take the helm. When physicians don't have the time or expertise to lead, they'll work with management companies to organize all parties involved. "Now you are getting a whole class of physicians who are understanding the business world and bridging the gap between clinical and administrative functions," says Dr. Davis.

2. Becoming part of a larger organization, whether it's the perioperative medical home or part of a hospital system, gives the organization negotiating power and leverage. "These organizations will be viable if they can deliver an excellent work experience where they can work at the top of their license and others can handle the management side of the practice," says Dr. Davis.

3. The larger organizations allow physicians control over their clinical and professional life. "There will always be physicians who want to work where they are appreciated, contributing and adequately reimbursed where they are respected and have some control," says Dr. Davis. This is where ASCs and large independent physician organizations will thrive.

4. Health information technology is the foundation of the larger organizations. The information technology helps people collaborate and provides data portability to multiple locations. "You can't do this without health IT, leadership and management," says Dr. Davis. "There are more freedoms with more data collection and transparency. You can become more independent because information technology disrupted the entire field."

5. The aging population will drive healthcare trends going forward, including the desire for integrated care in the perioperative medical home. The aging population will drive volume including orthopedic surgery, cataract surgery and colonoscopies. "We have a lot more information available about who our patients will be and we can tailor our operations toward them," says Dr. Davis.


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