How legislators view ASCs, the cardiology migration — former Sen. Bill Frist shares his thoughts

As a heart and lung transplant surgeon and a former Republican senator for Tennessee, Bill Frist, MD, has his finger on the pulse of healthcare in America. 

Here, Dr. Frist opines on how legislators think of ASCs and the potential migration of cardiology procedures to the outpatient setting.  

Note: Responses were edited for style and content. 

Question: On a national level, how do policymakers view outpatient surgery centers? 

Dr. Bill Frist: Overall, ASCs are seen as being on the right side of the cost curve in terms of providing quality care at lower cost than can be achieved currently with the cost and expensing mechanisms of inpatient care. Given the complexity of healthcare, there is still an opportunity to educate policymakers on this issue. 

Quality data suggest that ASCs provide both high-quality care and a superior patient experience, with an average savings of from 20 percent to 40 percent. The national average cost of a knee arthroscopy at an ASC is $4,720, versus $7,799 in a hospital. A 2016 study by Healthcare Bluebook/ASCA/HealthSmart estimates that moving cases to the ASC would save $38 billion annually. More than $5 billion of that would benefit patients, through lower deductibles and coinsurance.  

Americans routinely cite out-of-pocket costs as their top healthcare concern, and reimbursing for care in lower-cost, high-quality settings is something policymakers can point to as a way to move the needle on costs. 

Q: Enterprising physicians are moving low-risk cardiology procedures to the ASC space. Do you believe cardio can thrive in ASCs?

BF: Patient safety is the ultimate bottom line. As medical technology advances, procedures become less invasive, physician technical training stays current, and patient safety is ensured, procedures of all types will gravitate to the outpatient setting. The patient/consumer, bearing more and more out-of-pocket expense with high deductibles and coinsurance, will demand it.  And cardio is no different than orthopedics or general surgery.

Recently, orthopedic surgeons have begun the migration of total joints into the ASC setting based on payer and consumer demand for a lower cost and better patient experience. This has been ahead of CMS reimbursement for those procedures. Similarly, I expect more vascular and cardiac procedures to be safely performed in the high-value settings that ASCs can provide.

CMS continues to show confidence in doing cardio at an ASC by adding 12 additional codes to the list of covered ASC procedures in 2019.

Dr. Frist recently launched a podcast where he talks about healthcare challenges through the lens of medicine, policy and innovation. Listen to "A Second Opinion: Rethinking American Health with Senator Bill Frist, M.D.,", available on iTunes or wherever you access your podcast content. 

More articles on surgery centers:
Managing anesthesia services in ASCs — 5 top problems + solutions
5 questions to ask ASC anesthesia providers
CRH Medical acquires Florida gastroenterology anesthesia practice — 3 insights 

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