The struggle for ASC independence: Gastroenterologist Michael DiMarino weighs in


Michael DiMarino, MD, is a gastroenterologist practicing at Jefferson University Hospitals in Philadelphia. Here, he shares his thoughts on ASC growth, potential headwinds and more.

Note: Responses have been lightly edited for style and clarity.

Question: What's the No. 1 opportunity you see for ASC growth this year?

Dr. Michael DiMarino: Outpatient procedures in surgery centers have been on the rise as insurers recognize that hospital outpatient departments are costly, and as a result they want to push more procedures to ASCs. ASCs are able to give good care, be more efficient and less costly, which is appealing to payers. Low-acuity orthopedic and gastroenterology cases have migrated into ASCs, and there will continue to be procedure growth across the board.

Q: What do you think will be the greatest roadblock the ASC industry will face in the future?

MD: In New Jersey, there is a law that says you cannot open an ASC without it being a joint venture with a hospital. Now that hospitals are opening their own ASCs, there's going to be competition for patients for private ACSs. Hospitals want to keep patients in their own networks, so it's getting harder for ASCs to maintain their independence.

There's a reimbursement threshold that ASCs have to stay in business. However, it's more important for ASCs to maintain their quality and for ASCs to show their quality. That's where EHRs have been very important to our practice. We use Modernizing Medicine's gastroenterology EHR to collect data and prove our quality outcomes to insurance companies so they can adjust reimbursement accordingly. Everybody is getting squeezed with low reimbursements, but now is the time that insurers are pushing for more care to take place in outpatient facilities so reimbursements may increase, but only if the quality is there.

Q: How has the ASC industry changed since you began practicing?

MD: The acquisitions of ASCs by hospitals has been a big change, as well as the New Jersey joint venture ASC law. EHRs have been important, as they help us show our quality and document procedures better. If we spend a lot of time writing reports, it can be tough to keep the throughput going. EHRs have sped up the reporting process.

ASCs have to supply the same care at a lower cost to stay independent and keep their value. I think ASCs are better for patients because they enjoy being in that independent, less stressful environment. Additionally, patient satisfaction is driving reimbursements and allowing physicians to stand out. EHRs have helped coordinate these efforts.


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