The shift of higher-acuity, more complex procedures out of the hospital and into ambulatory surgery centers keeps accelerating, driven by advances in minimally invasive technique, anesthesia and robotics. But leaders say that growth is only sustainable if reimbursement, workforce and site-neutrality policy keep pace with it.
Becker’s asked ASC leaders two questions: What are the best opportunities for your ASC’s growth in the next two years, and what’s the No. 1 issue you’re following right now that could impact your ASC’s business in the future? Their answers, below, range from cardiovascular service line expansion to the site-neutrality rules reshaping where care is delivered.
Editor’s note: Responses have been lightly edited for clarity and length.
What are the best opportunities for your ASC’s growth in the next 2 years?
Judy Jarnigan, PhD, RN. Director, Nursing Specialty, Cardiology Services, at Ascension Alexian Brothers Medical Center (Elk Grove Village, Ill.): The greatest opportunity is continuing the migration of appropriate cardiovascular procedures from the hospital to the ambulatory setting while maintaining exceptional quality, safety and patient experience. Advances in technology, anesthesia and minimally invasive techniques are making it possible to safely perform increasingly complex procedures in ASCs.
Success will depend on developing strong physician partnerships, optimizing operational efficiency, leveraging data to improve outcomes and creating a patient-centered experience that is convenient, cost-effective and highly reliable. Organizations that standardize care, invest in workforce development — not just salaries — and build scalable cardiovascular service lines will be well positioned as reimbursement continues to favor lower-cost sites of care.
Leslie Voigt, BSN, RN. Vice President of ASC Strategy and Operations at Advocate Health (Charlotte, N.C.): The greatest growth opportunity for ASCs continues to be the migration of higher-acuity and more complex procedures from the hospital outpatient setting into the ASC environment. Advances in minimally invasive surgical techniques, robotics and anesthesia protocols are expanding the types of procedures that can be safely performed in ASCs while maintaining excellent clinical outcomes and patient satisfaction. As this shift continues, we are closely monitoring the financial and operational impact of these advancements, including the increasing need for extended recovery capabilities and appropriate infrastructure to support more complex cases.
Additionally, a key area of focus is optimizing OR and procedure room utilization through enhanced data analytics, dashboards and reporting capabilities. Leveraging technology and actionable data to improve scheduling efficiency, capacity management and operational performance will be critical to maximizing growth while continuing to deliver an exceptional patient experience and outstanding quality outcomes.
Rick Snyder, MD. Board-Certified Interventional Cardiologist and Advanced Heart Failure and Transplant Cardiologist at HeartPlace (Franklin, Tenn.): Partnering with independent primary care and multispecialty groups that are engaged in value-based risk models.
What’s the No. 1 issue you’re following right now that could impact your ASC’s business in the future and why?
JJ: The issue I am watching most closely is reimbursement and the continued shift in payer policies regarding site of service. As more procedures move to ASCs, reimbursement models must keep pace with the investments required to deliver safe, high-quality cardiovascular care.
At the same time, workforce shortages remain a significant challenge. Recruiting and retaining experienced nurses, technologists/scrub techs and procedural staff is becoming increasingly competitive. Organizations that successfully combine operational efficiency, workforce engagement, physician alignment and measurable quality outcomes will be best positioned to remain financially sustainable while meeting growing patient demand.
LV: ASC reimbursement remains the issue we are watching most closely, particularly as it relates to payer strategies and Medicare payment updates. Reimbursement rates have not kept pace with the increasing costs of labor, supplies, pharmaceuticals and technology, creating ongoing pressure on ASC financial sustainability and future growth.
To remain successful long term, ASCs must continue to balance operational efficiency, cost management and exceptional quality outcomes while adapting to evolving payer requirements and reimbursement models. Organizations that can effectively demonstrate value through clinical excellence, patient experience and cost-effective care delivery will be in the strongest position to thrive despite an increasingly challenging reimbursement environment.
RS: OPPS/ASC and MPFS proposed rules for 2027. As Dr. [Mehmet] Oz is quoted in their press release, “Medicare beneficiaries deserve a program that pays for the right care, in the right setting, at the right time. This proposed rule focuses squarely on patient affordability by strengthening our utilization tools, and removing the site of care disparities that have unnecessarily driven up costs for millions.” The site neutrality arbitrage is a huge driver for site of care choice by physicians as determined by their affiliation status, hospital employed or independent. “Such payment differentials can encourage health systems to shift services to higher-cost settings without a clinical need for doing so and may encourage greater consolidation within the healthcare system by motivating hospitals to acquire independent physician practices to increase their Medicare prices. Consequently, CMS is proposing to use its statutory authority to control unnecessary outpatient services volume increases used to equalize payment rates between physician offices and off-campus provider-based departments for certain imaging services.”
The combination of site neutral rules (continued erosion of the independent practice expense, more movement toward VBC, elimination of the IPO list, additions to the CPL, and leveling of the ASC and HOPD reimbursement for the same outpatient services) will continue to promote migration to the high-quality and affordable ASC settings.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
