The top barriers to ASC migration in 2021 — 5 thoughts from ASCA's CEO

While the pandemic has underscored the value of ASCs, they will continue battling reimbursement limitations, logistical challenges and consequences of COVID-19 going into 2021, according to Bill Prentice, CEO of the Ambulatory Surgery Center Association.

Mr. Prentice spoke to Becker's ASC Review on Dec. 9 about what is in store for his industry.

Note: Responses were lightly edited for style and clarity.

Question: What kinds of challenges do you foresee for specialties migrating to ASCs in 2021?

Bill Prentice: [The challenge is] less the specialty or the procedure than it is what kind of changes have to happen in the surgery center in terms of equipment or size of the room. Those are big predicates for some things. For cardiology, you need to have a different kind of room setup than you would have for other procedures. That's a big barrier to a lot of cases moving, and then the next largest barrier overall is reimbursement. If ASCs aren't reimbursed properly for that procedure, the likelihood of a surgeon bringing many of those cases there is pretty slim.

Q: Amid the pandemic and new CMS rules, what trends do you think will shape the ASC landscape in 2021?

BP: I'd say the pandemic has tragically exposed a lot of things about our healthcare system that work and don't work. One of the things it has shown on the positive side is the fact we have a decentralized healthcare system where you have places like surgery centers or off-campus HOPDs that are away from the main hospital. That's proven to be a really good thing. It's allowed the hospital to take care of patients impacted by the pandemic and then still have other sites of service away from those patients hospitalized with COVID-19 where [patients] can still get care. That's something we now realize is a benefit of the way we have this decentralized healthcare and not being overly consolidated.

In terms of concerns, we have millions of Americans out of work and losing access to their health coverage. They're still going to need healthcare next year, and I'm hoping that Congress and the administration will work to find ways to ensure those people can get the care they need. Relying on our Medicaid safety net is going to be really hard to do when we look at most state budgets right now. Medicaid is always a large cost for state governments. With the budget troubles that every state's having, it's going to be hard for those people to have access to care.

Q: Do you think the fact that patients are putting off care due to the pandemic will make it harder for physicians to find ideal candidates for the ASC setting?

BP: There were a couple months where most elective care was postponed, and [ASCs] are still seeing those patients returning. The volume of care in those surgery centers is not 100 percent, but close to it. There is the Hospitals Without Walls program that allows ASCs to become hospitals in order to take patients they otherwise wouldn't as a way to relieve pressure on the overall health system in their community, so I think we're finding ways to make sure everyone gets care they need.

The complicated factors are whether people have health coverage, patients are reticent to get care out of concerns about the pandemic, and there are additional costs now in terms of infection control processes and paying more for medical supplies and PPE — challenges we're still going to be working on for 2021.

Q: Are ASCs out of the woods in terms of being affected by elective restrictions?

BP: I would never say out of the woods. I think we have a very strong case now to show we can safely provide care during the pandemic regardless of a spike, which is something people questioned at the onset of the pandemic. I think we have a good story to tell about how we've been able to keep patients safe, and while we're paying more for what seems to be sufficient medical supplies and PPE, I don't see that as being reason to postpone care going forward.

Q: Do you think more ASCs will enroll in CMS' Hospitals Without Walls program as COVID-19 cases continue surging and elective restrictions are reimposed?

BP: They made some changes to the program at our request. Something we thought was an impediment to an ASC wanting to participate in that program [was the] 24-hour nursing [requirement] regardless of if you had a patient in the building or not. We have nursing shortages as it is, so to add to that doesn't make sense. We're grateful CMS changed that, and as I understand it, they're looking for other things they can do to make that program work better. It's something we'll continue to talk with CMS leadership about because we want to be able to help however we can, it just has to make sense.

The other thing is in order for that program to work, you need the hospital and health system in the community willing to shift that care. That was something we didn't see happening much in the early parts of this pandemic, and unfortunately as the pandemic is getting worse, there's probably a greater likelihood that cases may need to be shifted.

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