There are a number of highly publicized issues in the ASC industry, from declining physician reimbursement to the presence of major consolidators and inflation.
Here are the industry issues that four ASC leaders and physicians told Becker's need greater attention:
Ashwani Sastry, MD. Sunrise Heart and Vascular (Murphy, N.C.): The discrepancy between state [certificate of need] laws and federal/national coverage for cardiac procedures in the ASC setting. It's troubling that CMS and other payors have vetted the safety of cardiac procedures in the ASC, and have decided in the affirmative. Yet many, if not most, states have CONs that prohibit cardiac procedures outside of a hospital, and are very slow to change.
Larry Sobal. CEO of Heart and Vascular Institute of Wisconsin (Appleton): I regularly hear stories about ASCs that struggle to obtain payer contracts even though they would reduce the cost of care for an insured population. Whether or not this is due to health systems exerting leverage against the payers is uncertain, but it appears to happen frequently enough that it does not make sense.
Jackie McLaughlin, RN. Administrator of Premier Surgery Center (Stevens Point, Wis.): Let's go with the constraints of peer reviews with payors for procedure coverage. With the increased requirement of peer reviews, the amount of time physicians are available to spend time with patients examining, consulting and operating is greatly reduced. Patients are already experiencing longer than acceptable waiting periods to see their providers. This is now exacerbated by taking provider time away from the patient to only spend their time having to prove the necessity for their patient's medical interventional needs.
Robert Nelson, PA-C. Former Executive Director of Island Eye Surgicenter (Westbury, N.Y.): Office-based surgery [is] an area of concern [for] the ASC industry. Currently only hospitals and ASCs are held to extremely rigorous licensing and ongoing accreditation standards to be able to provide patient care safely and with reproducible outcomes. There are no shortcuts. Yet, there is a trend today to want to circumvent what has traditionally been a year's protracted process and find a shortcut to being able to do surgery in an office. It is said that office-based surgery facilities could be a cost savings, but not when patient safety is potentially compromised. There cannot be different standards that ASCs must adhere to, that are bypassed for the office-based model.