Private equity, physician-owned centers & more: Dr. Michael Rivers on ASC trends

Michael Rivers, MD, director of EMA Ophthalmology for EHR developer Modernizing Medicine, weighed in on the key ASC trends this year.

Question: What trends should ASC leaders expect to see this year?

Dr. Michael Rivers: ASCs are drawing increasing market emphasis in specialty practices, specifically ophthalmology and gastroenterology, due to the profitability potential for doctors combined with the cost-effectiveness for patients and the overall healthcare system. Additionally, some evidence has indicated superior patient experiences and outcomes in ASC settings compared to hospital outpatient departments.

Recently, I’ve seen more and more ophthalmologists moving toward ASCs as they’re efficient and offer excellent care without the hassles of a larger hospital setting. With the Medicare 2019 Payment Final Rule in effect, key ASC reimbursement trends fall in line with the main goal of reimbursing more ASCs and fewer HOPDs for certain ASC procedures — providing better care at lower costs.

For example, CMS’ 2019 Medicare ASC fee schedule increased ASC reimbursements by an average of 2.1 percent per procedure for 2019, which is nearly a full percent higher than the HOPD average rate increase of just 1.35 percent. While some ASC reimbursements still remain much lower than HOPDs, I foresee overall increased reimbursement for high volume procedures in the ASC as a continued trend for the coming years.

Based on these reimbursement trends, I would anticipate increased patient volume and procedures offered. I predict the continued increase of multispecialty ASCs as well as physician-owned facilities which will continue the trend of consolidation in the industry.

Q: How do you see private equity affecting the ASC space this year? Do you expect to see more or fewer deals?

MR: There is no denying the rising interest of private equity firms backing private specialty practices. This comes with both pros and cons. There is speculation that the rise in PE investment and influx in consolidation could impact personalized patient care and autonomy among physicians.

On the flipside, many physicians are drawn to sell their practices because of funds from an initial buyout and increased access to resources (staff, funds and tech), all while reducing the administrative burdens in hopes to alleviate some of the causes of physician burnout.

Specialty practices that are not associated with health systems are continuing to follow the trend of aggregation. From my experience, I’ve seen that ophthalmologists often have their own ASCs and tend to band together with other area ophthalmology practices to keep a physician-owned facility and join forces.

I would anticipate more deals with fewer PE firms in the mix and a potential increase in physician-owned ASCs.

Q: What technology trends (or new technologies in general) should ASC leaders know about?

MR: Without an investment in adequate technology, inventory management and streamlining patient paperwork will continue to pose challenges. Adopting an ASC inventory management system platform is a must, and easily customizable workflows are needed to conform to unique schedules. It’s important to note that ASCs should invest in inventory software that interfaces with an EHR platform and practice management system versus forcing different platforms together.

A well-designed specialty EHR system, paired with surgical planning and inventory software, should automatically create pre-op, operative and post-op reports for the circulating nurses and surgeons. Data filled out in the pre-op report should automatically populate in the operative report so that it’s ready for the surgeon to review and sign immediately post-surgery. The inventory used during procedures should have the ability to be scanned and automatically tracked with reporting taken care of on a per-patient basis.

Detailed inventory tracking provides visibility into ordering trends, current stocks and expiring inventory while helping to predict future ordering needs and meeting FDA documentation regulations, especially with product recalls. For ophthalmology specifically, better tracking of intraocular lenses (IOLs) and surgical packets are necessary to help improve efficiencies and could help with overall budgeting and cost savings.

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