The state of ASCs in Texas — 4 industry leaders share

Over the last four years, no state has seen more new ASC activity than Texas. 

Here, Susan Cheek, former Texas Ambulatory Surgery Center Society president and administrator of Dallas Endoscopy Center; Woodrow Moore, founder of the TASCS; James McClung, BSN, RN, TASCS board member; and Adam Bruggeman, MD, administrator of Texas Spine Care in San Antonio, discussed the state of ASCs in Texas and where they see the industry going in 2021.

Note: Responses were presented alphabetically and edited for style and content.

Question: How are ASCs in the state thriving, and what's in store for 2021?

Dr. Adam Bruggeman: ASCs are already experiencing significant growth in 2021. In Texas, we are seeing growth in a few areas. First, Texas is seeing growth through the development of new ASCs throughout the state. In my area, we have seen several new ASCs over the last two years, and there are several more in development. The other ongoing growth is through changes in service lines. Orthopedic surgeons and neurosurgeons are increasingly looking for overnight stay beds to bring higher complexity cases. Also, we are seeing cardiologists look into moving cases over to ASCs.

Several factors are driving that new growth. The most obvious is the COVID-19 pandemic. Cardiologists were displaced without a place to perform procedures and are looking to survive in the face of shutdowns. Similarly, orthopedic surgeons and neurosurgeons have seen cases delayed related to the availability of resources at hospital systems. ASCs have primarily been allowed to continue operating, despite elective surgery delays at major hospitals, creating opportunities for surgeons to have a more consistent operative practice even during the pandemic shutdowns. Patients are also increasingly asking about how many COVID-19 cases are present at a given facility. The ability to have a procedure performed at a facility that cannot accept COVID-19 patients is a driving factor in those patients' decisions. The other factor that continues to drive growth is physician-owned hospitals' inability to expand or take Medicare if they create a de novo hospital. Meanwhile, ASCs can be built for far less investment and allow for expansion and physician ownership without impact on the ability to take Medicare patients to the facility. Finally, physicians are noticing the opportunity to capitalize on a sale of their facility as they develop and grow a surgery center and sell to one of the many large ASC companies for significant profits.

We will need to continue to watch several other ongoing trends. These include the consolidation of ASCs by ASC management companies. This consolidation may reduce the benefit of ASCs for insurance carriers and ultimately affect the desirability of ownership of ASCs in the future. As physicians also become increasingly employed by hospitals, they will be far more likely to invest and work at hospital outpatient facilities or hospital-owned ASCs. The out-of-network strategy for many ASCs has also diminished significantly in the last several years. Fewer ASCs are finding the benefit of staying out of network, although this may shift again with new laws in Texas and federally regarding negotiations for out-of-network reimbursement. Finally, there has been a persistent attack on physician ownership of ancillaries in federal legislation. Will ASC safe harbors be brought up and diminished or eliminated in Congress? This is a low likelihood, but a renewed focus on healthcare could ultimately bring various ancillary revenue sources into legislative conversations.

The future of ASCs in 2021 is very bright. How bright? It depends on several competing interests. I suspect most physicians will be happy with the future of ASCs by the time we turn the clock to 2022.

Susan Cheek: The outlook for ASCs in Texas for 2021 should stay stable. While there has been some downturn in case volume, due to patients still being concerned about COVID-19, the safety of having procedures in the ASC setting should help the future stay bright. Patients still need procedures performed, and the ASC is a safe environment, as ASCs are not treating COVID-19 and are screening patients while limiting access of others to their facilities. This message needs to be said more, as it is very important that patients do not put off these important procedures.

James McClung: Texas is a very healthy state for growth in healthcare right now. Texas is not a certificate-of-need state and does an excellent job in supporting small businesses (not to mention there is a lot of space to expand and grow). I believe in 2021 that independent surgery centers will unite in a more organized way to use their resources to build relationships with hospitals and management companies more as peers than as a competitor. The independent ASC industry has been the leading industry for a large portion of the innovation happening in controlling medical care cost and providing more for less.

Woodrow Moore: ASCs in Texas are continuing to provide safe and much-needed care throughout the COVID-19 pandemic and are continuing to prove their value in the healthcare system. This year promises continued growth of the industry and especially growth of the independent centers.

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