Will independent ASCs go extinct?

ASCs around the country are facing reimbursements that are not keeping up with the rising cost of living, leading to a declining number of truly independent, physician-owned ASCs. 

Melissa Hermanson, DNP, RN, administrator of Vineland, N.J.-based Ambulatory Care Center, joined Becker's to discuss how this issue has affected her ASC. 

Editor's note: This response was edited lightly for length and clarity.

Question: If declining ASC reimbursements are not adjusted, how do you see the ASC industry shifting?

Melissa Hermanson: We've already seen what happens. There are very few freestanding, physician-owned centers left without either an affiliation with a management company or a hospital system in their area, because it is next to impossible to be able to run a center. 

My center here is one of the most efficient centers that I've ever seen — I have a board of directors who is very hands-on and watches the numbers and how much we're spending on everything. We are very, very conservative when it comes to spending. Even as much as we pay attention to all of those things, it's very tough. Definitely in the future, we will be involved with a bigger entity. I think that that's how everybody is going at this point. You have more purchasing power with a hospital, you get better group purchasing rates. There's a lot of advantages that may help you to lower your prices on the procedure. And, hopefully, they have the strength to help you get a better reimbursement as well. 

The whole thing is so frustrating. Especially when you have a center like mine, which is really committed to the community regardless of what kind of insurance you have, regardless what kind of background you have. We want to make sure everyone feels welcome and taken care of here. It's challenging. It's frustrating that the restraint is on the part of the payer and what they're willing to reimburse. Why are we advocating so hard for the patients when the payers aren't trying to protect them at the same time? That's what's really frustrating, especially because so many of our patients are kids and we really want them to get the care that they need. But if you're not savvy to how the contract negotiations go — and I think that a lot of people really aren't, because I think there's a misconception that you can't negotiate with Medicaid payers — that you're kind of stuck with what you get. But the reality is that you do have some leverage there. 

Q: Do you expect these reimbursement obstacles to continue?

MH: I think it's really going to depend on how the numbers look and if CMS really pushes patients out of the hospital and into the outpatient arena. Because if that is truly how things go, and it's not just flip-flopping, then they're gonna have to increase reimbursements because we have to be able to still provide care. We can't do that without, you know, reimbursement that at least covers the case.

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