What ASCs are doing to stay relevant

ASCs earned an elevated role in the healthcare ecosystem during the pandemic, as many stayed open to provide surgery for patients without COVID-19 when hospitals ended nonemergency services. Now, insurers and investors see big opportunities with ASCs as a high quality, low-cost setting for care.

But as their profiles rise, ASCs also must change to stay relevant.

"We will continue to see more cases, as well as more complex cases, migrate to the ASC setting due to its clear value proposition," said Beth LaBouyer, RN, executive director of the California Ambulatory Surgery Association. "In particular, there is continued growth in orthopedics, gastroenterology and cardiovascular cases. As an industry, we have to be prepared to meet this growing demand, which means building out the surgery center teams, refining processes and prioritizing quality training to ensure case migration is done the right way."

Ms. LaBouyer said forward-looking ASCs track the evolution of healthcare trends and needs of patients. ASCs across the U.S. are expanding service lines and adding capabilities, including total joint replacements and spine surgery. On the current trajectory, outpatient total joint replacement volume is expected to outpace inpatient volume by 2029, bringing with value-based care opportunities for ASCs.

"ASCs need to prepare for this by implementing total joint programs, dedicating operations teams and clinicians who specialize in this and working with vendors, facility partners and physician groups to be ready to transition more of these cases into the ASC setting," said Ms. LaBouyer. "Additionally, physician specialists need to nurture their connections to value-oriented primary care providers and payers as a way to care for more patients."

Oren Shill, president-elect of the California Ambulatory Surgery Association's board of directors and group president of Surgical Care Affiliates, said specialists are now looking for ways to participate in integrated care delivery models and value-based care to fortify practice sustainability.

"ASCs must work hard to build awareness of their benefits, attract physician specialists and nurture the connections to value-oriented primary care doctors and payers to reinforce siting of patient cases at ASCs," said Mr. Shill. "We are also making investments in talent acquisition, leadership programs and training for clinical and support teams to attract and retain top talent with compelling career growth opportunities."

With the shift to value-based care, surgery centers are preparing for a data-driven future by purchasing or upgrading their electronic systems to track operational efficiencies, revenue cycle and patient outcomes. Hospitals and insurers already have data systems primed for value-based contracting, but many surgery centers are still on paper records or have simple practice management software that won't provide the advanced analytics necessary to negotiate beneficial bundled payments.

"Technology is key as we move toward an outcome-based payment structure from the traditional fee-for-service. Many payers are approaching us about bundles and outcome data," said Jeffrey Flynn, administrator and COO of Gramercy Surgery Center in New York City. He said he is worried AScs without EHRs will be left behind as new payment structures emerge.

The other area where Mr. Flynn sees ASCs evolving is with patient and surgeon experience. ASCs need a steady stream of patients and great reputation among surgeons to generate business, and the needs of both groups are changing.

Patients demand a seamless care experience with patient portals, online scheduling and easy billing in addition to great outcomes and kind care teams. The next generation of physicians wants a work-life balance, mentorship from senior partners and a clear path for professional growth, in addition to advanced technology and community partnerships.

"If you provide not only a safe and technology-advanced setting, but one that makes the patient comfortable and the surgeon happy to be there, you have attained most of what you want to accomplish," said Mr. Flynn. "You also must stay aware of payment and regulatory issues you will be facing and be proactive to the changes — not reactive."

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