During a presentation Oct. 27 at Becker's ASC Review 24th Annual Meeting: The Business and Operations of ASCs, held in Chicago, two administrative ASC leaders identified six key trends driving change in the outpatient landscape in 2018.
Presenters included:
- Don Phalen, vice president of business development at Regent Surgical Health (Westchester, Ill.)
- Mark Murphy, chief strategy officer at St. Joseph's Health (Syracuse, N.Y.)
Here are six trends for ASC leaders and physicians to know.
1. Macro trend: Value-based care. Mr. Phalen said the macro trend in outpatient healthcare is the industry's transition to value-based payment models.
"The healthcare industry's evolution away from fee-for-service care continues to gain traction and is changing the game for ASCs as the quest for value replaces volume, and hospital systems are striving to optimize ASC platforms by embracing the strategic, structural and operational approaches to enhance value-based care strategies," Mr. Phalen said.
Mr. Murphy warned ASC administrators against waiting until the last moment to prepare their facilities for value-based surgical models.
"People ask me, 'How quickly are we moving toward value-based care? What if we just ride the tailwinds of fee-for-service as long as we can?'" Mr. Murphy said. "The expectation is that we can just flip a switch and automatically be ready for value-based care, but in reality, we know making the transition takes time, capital investment and discipline."
2. Total joint replacement. The shift of TJRs from hospitals to outpatient settings is ongoing. The volume of outpatient TJR procedures is projected to grow by 45 percent by 2025.
"Considering the many benefits of outpatient surgery, some stakeholders were expecting the migration of TJR procedures from inpatient to outpatient to move faster," Mr. Murphy said. "But there have been a lot of hurdles; payers weren't prepared, the surgeons weren't comfortable and the clinical staff wasn't there. Making this shift took strong leadership from hospitals and physician groups."
3. Bundled payments. Bundles are the fastest growing alternative payment type. Some stakeholders expect bundles to account for 17 percent of all medical payment types within five years, according to ORC International.
"In addition to technological advancements, cost savings is another factor driving migration to outpatient settings," Mr. Phalen said. "There are many different bundled payment possibilities, and which one is the best bet for your facility is extremely dependent on the ASC and payers and competitors in the market."
Many ASCs already practicing bundled payments are doing so with orthopedic procedures, including TJRs. Unlike treating chronic or congestive conditions, orthopedic procedures are more predictable for physicians to manage. Learning how to implement and execute orthopedic bundles is key to more successful payer rate negotiations in value-based medicine, Mr. Murphy said.
"Those ASCs that have prior experience and success in executing TJR bundles will be highly sought after and valuable to health systems and payers moving forward," he said. "Getting to that level requires ASCs to make IT, clinical and labor investments today."
4. Hospital outpatient department conversions. Although Medicare reimburses HOPDs at significantly higher rates than ASCs, hospitals and health systems are transforming their HOPDs into joint-ventured ASCs with physician groups and private operators.
"Hospitals and health systems are no longer looking to outpatient departments to generate revenue," Mr. Phalen said. "What's more important to them is to manage the cost of an entire episode of care. That means many are interested in working together with ASCs and physician groups as partners in care."
5. Employed physicians as ASC partners. As health systems build strategic ambulatory channels that leverage ASC joint ventures as important physician recruitment and retention tools, the once ill-advised practice of offering employed physicians ownership in ASCs has become increasingly popular. Although health systems are privy to the trend, Mr. Murphy said most systems are focused on more immediate concerns, such as establishing partnerships with local physician groups.
"The discussion about employed physicians trying to move patients and surgeries to outpatient settings is on the back burner for now," Mr. Murphy said.
6. Specialty centers. Health systems see value in building robust ambulatory arms that include a diversity of specialties. Cardiology in particular has emerged as a sought-after specialty to have in a hospital's outpatient wheelhouse.
"Cardiologists are looking at their orthopedic colleagues moving procedures to outpatient settings, and they want payers and health systems to offer them similar incentives to move cardio procedures to outpatient clinics," Mr. Phalen said.