As payers push for site neutrality and surgeons grow restless with hospital inefficiencies, the ASC industry is no longer a peripheral player in healthcare.
Health systems are now faced with a choice to either embrace the ASC model or watch their physician talent walk out the door.
Janet Carlson has seen both outcomes up close. Ms. Carlson, a veteran ASC leader who recently founded her own ASC consulting company, Vertex Surgical Solutions, joined Becker’s to discuss how the hospitals winning this moment are the ones getting creative about how they retain surgeons, structure joint ventures and optimize where patients get their care.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Are you seeing hospitals beginning to accept ASCs? Is the friction getting worse?
Janet Carlson: It’s a little bit of everything. Some hospital systems are forward thinking and have created positions for ASC leadership within their structure — usually a VP of ASC Operations. Those systems are embracing the ASC as part of their holistically integrated network. There is friction from the health systems that don’t want to let go of HOPD rates. ASCA just introduced new legislation about removing that scaler on HOPD, so that we can have site neutrality and fair reimbursement. The health systems that are reluctant to give up HOPD rates — that’s where the friction is coming from. They’re not embracing the change. They need to understand that the ASC helps remove high-volume, low-acuity cases so that the big hospital has more capacity for higher-acuity, more seriously comorbid patients. It’s about optimization — placing the patient in the correct site of service. With the right guidance, that can actually open things up for them and make them very successful.
Q: Could you characterize what’s at stake for hospitals and health systems that don’t develop ASC strategies?
JC: They’re going to be left behind. A lot of surgeons are considering leaving health system employment and looking for opportunities to go independent or join an independent MSO — a multispecialty practice where they can hang out their own shingle. Health systems are going to see that shift. Physicians get frustrated by limited block time and the inefficiency compared to an ASC. They want to tackle their patient surgery list and move forward, but the frustration — combined with the value proposition of owning shares in an ASC — is very attractive. We’re even seeing this with younger surgeons, newly out of fellowship, who have left health systems to strike out on their own. I really admire that.
Q: Is there a specific type of physician you’re seeing making that shift?
JC: Orthopedics. And health systems are also eliminating their pain platforms if they haven’t already. Most interventional pain now is in procedure suites, office-based labs and ASCs.
Q: What would a truly ideal hospital-ASC joint venture look like, and how close are we to getting there?
JC: The forward-thinking health systems are going to get ahead of this by getting creative in how they retain their surgeons. What that might look like is: an employed surgeon working in an ASC is typically incented on an RVU structure, but when you take a case to an ASC, your RVUs are going to be lower. If they can legally find a compliant way to recognize what that surgeon is doing by taking the patient to the correct site of service — and creating capacity in the big hospital — that would be ideal, so the surgeon isn’t financially penalized.
The other piece is allowing physicians to have shares in the ASC, or some percentage of the facility fee. Any health system that gets creative around that is likely to have higher surgeon satisfaction and flexibility — surgeons can work in an ASC for the right-acuity patient, then flex back to the hospital for higher-acuity or required inpatient cases.
But it has to be a true joint venture, and it can’t be one without surgeons at the forefront — driving the initiatives and defining what good looks like. There are health systems out there working toward this, and I commend them. Others are just going to stick their heads in the sand and hope everything stays the same.
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.