10 issues ASC execs are obsessing over

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The healthcare ecosystem is changing rapidly and administrators are following 10 big trends to prepare for the future.

1. The pandemic sparked accelerated consolidation in the field, with ASCs and physician groups joining larger organizations or selling to a hospital. ASC administrators anticipate more hospital-physician joint venture centers and increased private equity investment in the future.

"There is so much consolidation going on in the sector between health system acquisition and private equity penetration into the market, I follow this closely as I think the continued insurance market dynamics and the ongoing pandemic recovery will only further accelerate this activity as both an offensive posturing for some and a defensive posturing for others," said Glen Silverman, CEO of Mississippi Sports Medicine Clinic and Orthopaedic Center in Jackson.

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2. CMS and commercial payers are migrating more cases to outpatient surgery centers, and in some cases requiring procedures be done in the ASC. Will this trend continue?

"As the 1,700 procedures come off CMS' inpatient-only list, I expect additional opportunities for the ASC," said James Zenman, PhD, CEO of The Cardiac and Vascular Institute in Gainesville, Fla. "I am hoping that CMS will keep up with this trend and acknowledge our ability to do more and more cases in the ASC at less cost. So, I am working with legislative staff to move this along."

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3. Patients are becoming savvier about the cost of care, which leads them to the ASC.

"For the longest time, we have been discussing the ability of consumers to drive case migration through choice of the outpatient setting over the hospital due to the cost factor," said Andrew Lovewell, administrator of the Surgical Center at Columbia (Mo.) Orthopaedic Group. "I foresee that increasing. With the increase and adoption of more high-deductible plans, and the onus being put on the consumer to drive their own healthcare vehicle, there are going to be some breakout benefactors. ASCs could be one."

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4. Price transparency could be a boon for surgery centers as compared to hospitals, but may also depress prices in ASC-saturated markets. If centers compete against each other on price without a quality component, the price transparency movement will be a race to the bottom.

"Price Transparency technologies as well as patient engagement tools in the form of notifications, education, and reminders, and health tracking tools such as smart watches are all intended to coordinate care and enhance the healthcare experience," said Becky Ziegler-Otis, administrator of Ambulatory Surgery Center of Stevens Point (Wis.). "Keeping abreast of these technology trends is important in looking for opportunities to leverage them in the ASC environment."

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5. There are more concerted efforts to collect and report ASC quality data. CMS made changes to how it's collecting quality data, and surgery centers are thinking more now about how to promote that information as patients shop for their care.

"Over the last several years, we have made significant investments in staffing and in developing processes and systems for measuring and tracking quality outcomes," said John Lewis, CEO of Semmes Murphey in Memphis, Tenn. "We have been a major contributor to a national clinical registry for common neurosurgical procedures, and that infrastructure allows for reporting and analyzing the quality of care we provide. We are also developing a similar infrastructure to track the conservative, non-operative care we provide to our patients. As we continue to expand this program, it gives us the data we need to hold ourselves accountable and to continue to elevate the quality of care we provide."

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6. Employers are seeking out direct contracting with providers and ASCs are stepping up to the plate. Administrators in several markets are working with large employers on elective surgery contracts, cutting out the payer.

"As ASCs are now increasingly recognized as a high-value provider of care they need to be ready to demonstrate the potential savings and top quality outcomes they produce," said Andy Poole, CEO of Monticello Community Surgery Center in Virginia's Albemarle County. "This offers greater opportunities to work directly with self-funded employer groups through direct contracting or with third-party payers in narrow network or center of excellence type models."

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7. Patients with high deductible health plans and employers are driving demand for bundled payments from surgery centers. Insurance companies are also more willing to negotiate risk-based bundles with centers than in previous years, and ASCs with the right data and processes to develop pricing for global episodes of care will benefit.

"There is an ASC trend in shifting payments to value based bundled payments from commercial payers and from CMS through their focus on implementing a program to reward centers for providing value, outcomes and innovations," said Ms. Ziegler-Otis. "Clearly this transition will have an impact on surgical center revenue cycle and metrics tracking."

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8. Robotics and new technology purchase are becoming a "must -have" for orthopedic surgery centers. Early career physicians trained on the technology and use it in the hospital; in some areas, ASCs need robots to keep up. But will vendors meet a price point that makes sense for ASCs?

"We are watching the robotics market with intrigue. We currently have three robots in our ASC but they take up an enormous amount of space," said Mr. Silverman. "As newer versions come out we will be looking for decreased storage space, decreased consumable cost and decreased time of applying the technology intraoperatively."

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9. The pandemic amplified staffing challenges and nurse shortages across the U.S. Now that elective surgeries have largely recovered normal volume, ASCs want to grow, but can't do so without the right team in place.

"It is really difficult to hire and keep staff," said Dr. Zenman. "This pandemic has left many facilities short of talented help. We have to pull out all of the stops to ensure that we keep our good people and develop a system to ensure that they are rewarded appropriately."

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10. What will the ASC landscape look like post-COVID-19? What policies and processes will ASCs keep and how will the pandemic change the landscape forever? ASC executives are keeping a close eye on the permanent impact of the pandemic as they plan their next moves.

"The pandemic was a direct accelerator for the other items and continues to bring uncertainty around the areas of supply chain, pricing and stability of budgeted volumes," said Mr. Poole.

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