Joe Peluso, administrator at Aestique Surgical Center in Greensburg, Pa., joined Becker's to discuss what he thinks the ASC industry looks like and will look like as healthcare costs continue to rise.
Editor's note: This response was edited lightly for length and clarity.
Joe Peluso: The ASC industry is standing strong, finding creative ways to shore up under challenges to healthcare, poised to deliver high-quality, safe, accessible and cost-effective services to meet their profitability goals. ASCs' management of financial, personnel, and operational resources will help ensure the effective prioritization of outpatient care without increasing the cost of care. ASCs' financial and operational outlook shows encouraging signs of gradual continuous growth for the future of outpatient care. There is significant optimism among ASCs for additional/new revenue.
An increasing portion of healthcare providers' revenue is now coming directly from patients. More than 75 percent of patients with employer-sponsored coverage are enrolled in a health plan with an annual deductible and more than 50 percent of covered patients are enrolled in a high-deductible plan. The average family plan has an annual average deductible of at least $8,000. The way benefits are administered is also growing more complex. This shift in financial responsibility, paired with unprecedented economic conditions associated with the pandemic, has had a major impact on healthcare organizations volumes. Procedures performed in ASCs provide significant economic advantages to patients and payers.
Outpatient surgical procedures performed in ASCs have continued to grow over the last several years due to significant economic advantages to patients, physicians, payers and the healthcare industry. Overall, the ASC market is projected to continue to grow, and alternative business models will be developed as the key players look to maximize efficiency and clinical success.
CMS and commercial insurance payers are updating their policies that are anticipated to accelerate the transition of more complex surgical procedures to ASCs that have been proven to be safely performed with high quality and less cost. Surgical procedures that had been restricted to the inpatient only lists are being slowly transitioned by new site-of-service policies, which is a logical progression of providing surgical care in high-quality and lower-cost ASCs.
In recent years, several higher-acuity and higher-reimbursed procedures have been added to the ASC-payable list and this trend is expected to continue. Specialties that will continue to transition include total joint replacements, cardiology and spine procedures. The ASC setting has been proven to be more efficient leading to greater productivity and lower costs. These changes, along with pending legislation, will help level the financial playing field for outpatient surgery procedures that will result in driving volume and payment growth to ASCs in coming years.