Healthcare is constantly changing, but there are certain key concepts that can help ambulatory surgery center owners and operators prepare for the future.
At the Becker's 13th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine, several industry leaders came together to discuss the most important aspects of preparing for the next five years. The leadership panel included Regent Surgical Health Director of Business Development Christine Henry Musa; Surgical Care Affiliates' Senior Vice President of Operations Goran Dragolovic; Founder and President of NeoSpine Richard Wohns; and Director – Outpatient Solutions at DePuy Synthes Advantage Bill Wilder.
1. Payment innovation. Healthcare providers and patients are taking on more risk with bundled payments, accountable care organizations and other new payment models. ASCs are in a great position to work with other stakeholders to improve the quality of care while lowering the cost.
However, payers have difficulty developing bundled payment for surgery centers. SCA is creating synthetic bundles where physicians get a premium on their professional fees to use designated facilities.
2. Physician employment. Specialists are employed more often today than they were in the past, and a higher volume of surgeons coming out of medical school are opting for employment contracts or large independent physician groups. However, Dr. Wohns sees opportunities for smaller physician groups to continue to thrive. NeoSpine is building a larger practice with more services available in a more metropolitan location that caters to increasing demand.
"We think that this sort of carve-out is really the ticket toward success in the future for what everyone wants. It's better access and better quality because surgeons at the ASC are doing lots of these procedures, and they can achieve the best outcomes because this is what they're doing day in and day out," says Dr. Wohns.
3. High-acuity cases. More complex orthopedic procedures are going into the outpatient setting and ASCs. Traditional orthopedic implants are expensive and without the appropriate contracts and industry partners, ASCs may not be able to support these cases.
"We look at the ambulatory surgery center really as the hospital of the future," said Mr. Wilder. "If you look at orthopedic spend in the last year, it's about $1.5 trillion market right now across the orthopedic landscape: biologics, power, spine, trauma, sports, joints. We expect that market to double in the next six to eight years, and we believe the ASC is really the hospital of the future that will be principally be driven by elective orthopedic cases. We believe many in of the orthopedic cases patients aren't sick; they are injured and want to go home. We recognize this is the space we need to play in and partner in with our ASC customers and our surgery customers."
There has also been a migration of total joint replacements to ASCs. However, negotiating contracts with payers is still a challenge, said Ms. Musa. Insurance companies are looking for data to negotiate payments for total joint replacement procedures. During negotiations, ASC leaders can compare the cost for total joint surgery at the ASC to the hospital rates and show savings in the outpatient setting.
4. Medical mall model. Healthcare providers are more focused on providing care for the "whole patient" today than in the past, making it convenient for patients to receive the continuum of care within a single location or time period. Outpatient surgery centers are following this model by joining medical malls where imaging, physical therapy and other ambulatory services are available on the same outpatient campus.
"Right now we are looking at the emergence of retail in healthcare and movement toward medical malls. That's something we are paying more attention to now mainly because it helps us achieve the goal of bringing care closer to the patient and making it more convenient to the patient," said Ms. Musa. "The biggest concern is really to create the environment of care for the patient."
5. Reputation still matters. Insurance companies are putting patients into narrow networks and hospitals are employing primary care physicians, which changes some traditional referral patterns to specialists. However, in many communities reputation and word-of-mouth is still paramount for independent physicians.
"This matters more than networks, I believe. We get lots of patients who are referred in a network to a surgeon they don't want to see, or someone they've already seen and they want to go outside. They ask around to neighbors, friends and family," said Dr. Wohns. "I'm very surprised at the amount of information patients have on their physicians. They shop around. They look on the internet and HealthGrades. They talk to all kinds of people — their co-workers and employees looking for the right surgeon."
When the patients talk to several people who all recommend the same specialist, it helps the independent physician's practice grow.
6. Leverage your clinical results. Electronic medical records and software systems help healthcare providers collect clinical quality and outcomes data. Physicians and ASCs are learning how to leverage this data in contract negotiations to prove quality and drive better rates. They can also use this data to market and grow their practice in the future.