Physicians are increasingly looking to align with hospitals, for both noneconomic reasons — like security and quality of life — and economic reasons, like investment requirements for IT and hospital-based reimbursements, according to Ms. Higgins. For physicians in ASCs, alignment can mean HOPD conversion and entering into a co-management agreement post-transaction.
The presenters suggested asking considering three questions to determine if HOPD and co-management is right for the organization:
1. Do the current owners want to sell the business?
2. Do the physicians want to remain independent?
3. Do the physicians want to work with the hospital to co-manage the center to improve quality outcomes?
“If these three get the OK, then HOPD could be right for your center,” Ms. Higgins said.
As with any decision, there are pros and cons associated with ASC conversion to HOPD and the subsequent co-management agreement. Pros Ms. Higgins shared included that physicians can remain independent but do not have to carry the burden of IT costs and are placed on the right track to getting paid for outcomes. Some potential cons to the conversion are that physicians will likely have to commit to quality committee meetings and may be required to track their time.
Ms. Szabad shared four main legal statutes to look out for when ASCs are converted and a co-management agreement is signed:
1. Anti-Kickback statute
2. Stark Law
3. False Claims Act
4. Civil Monetary Policy
“There are some other considerations…but from an ASC perspective, those are the ones you’ll be primarily concerned with,” she said.
With that said, there seem to be fewer co-management agreements happening after HOPD conversion, according to Ms. Szabad. “I have been seeing a lot of ASCs being purchased by hospitals and converted, but less and less of co-management agreements,” she said. “I think part of that is that they are really time intensive.” The agreements have to be constantly monitored and reviewed and updated annually. “Hospitals have to be up for the challenge, and the physicians do too.”
