Democrats won majorities in both the House and Senate in the Nov. 3 midterm elections, the first time the opposition party has controlled both chambers during a Republican presidency since 2006.
The party’s early healthcare agenda centers on restoring the enhanced ACA premium subsidies and reversing nearly $1 trillion in Medicaid cuts from HR 1. President Donald Trump still holds veto power, and the new Congress is sworn in Jan. 3.
Ten ASC and outpatient surgery leaders shared what the results mean for their organizations and the industry.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What do the election results mean for your ASC, your organization or the outpatient surgery industry?
Scott Bennett. CEO of US Digestive Health (Exton, Pa.): The election results may change the policy agenda, but our priorities at US Digestive Health remain consistent: preserve patient access, support our clinical teams and expand access to high-quality, affordable outpatient care. I see an opportunity for bipartisan progress on reimbursement that supports care in the most appropriate setting and reduces unnecessary prior authorization requirements. We will be watching Medicare payment policy and Medicare Advantage oversight closely, with a focus on whether changes make it easier for patients to receive timely care. For our industry, the strongest message to policymakers is that investing in outpatient capacity can improve access and help address healthcare affordability.
Peter Bravos, MD. Chief Medical Officer of Sutter Health Surgery Center Division (Sacramento, Calif.): Elections shift policy, but they do not shift the direction of surgical care. Affordability, access and site-of-care optimization will define the agenda for health systems regardless of who governs. Meeting those demands, however, will take more than owning surgery centers. The opportunity is to build an integrated ambulatory surgical platform that moves patients to the right setting, aligns physicians around shared goals, maximizes OR capacity and safely takes on more complex cases.
Ray Brown. CEO of Lake Lucien Surgery Center (Maitland, Fla.): I really wish more of these elected officials were educated about our industry. I don’t think you will ever hear anything more than “broad strokes” from them. When policymakers lack that depth of understanding, well-funded lobbying interests can have an outsized influence. Independent providers and the patients we serve need a meaningful voice in those discussions, and that doesn’t happen often enough.
Kevin Connor. Founder and CEO of PulsePoint EP (Tampa, Fla.): The market gave the clearest read the morning after the election: Hospital and device stocks rallied sharply, pricing in more insured patients and more procedure volume. The bigger question for our industry is where those procedures happen. With a divided government and gridlock on most major issues, site-of-care reform and patient access stand out as rare areas of real bipartisan support, from site-neutral payment to price transparency. I expect them to get more attention, not less.
The regulatory momentum is already there. CMS made cardiac ablation payable in ASCs this year, and electrophysiology is one of the clearest cases of a high-cost hospital procedure that can move to a lower-cost setting without compromising quality. The next fight is at the state level, where certificate-of-need and licensure rules still lag CMS. Those legislative sessions open in January, and that’s where this election will matter most for outpatient cardiology.
Krista Edelman, MD. Gastroenterologist and Partner at Richmond (Va.) Gastroenterology Associates: This week’s election results may signal a growing appetite for greater oversight and scrutiny of healthcare consolidation. As a partner in an independent practice, I hope this translates into renewed attention to site-neutral payments and the role consolidation plays in driving healthcare costs higher. ASCs are a critical part of the solution, offering high-quality, lower-cost care, yet independent centers often compete on an uneven playing field with hospital-owned facilities. CVS’ decision to separate its retail pharmacy business from its insurance and PBM operations also reflects growing awareness of the complexities of vertically integrated healthcare. I hope we see renewed oversight of these models and are able to implement policies that support competition, independent physician ownership and the continued growth of ASCs.
Dev GnanaDev, MD. Chairman of the Department of Surgery at Arrowhead Regional Medical Center (Colton, Calif.): Democrats are talking about eliminating Medicaid cuts and restoring subsidies for Obamacare enrollees as one of their top priorities. This would ease some of the financial burden on low- and lower-middle-income populations. It may help ASCs that take Medicaid patients, but the majority of ASCs don’t accept Medicaid because reimbursement is less than the cost of providing care.
I am not sure Democrats will be enthusiastic about site-neutral payments. Their general feeling is that hospitals deserve higher payments because they are obligated to care for all patients under EMTALA.
Congress will investigate all the drug deals made by the Trump administration. That may or may not lower drug costs for ASCs.
John Goehle. Chief Operating Officer at Ambulatory Healthcare Strategies (Rochester, N.Y.): I think the biggest issue coming out of this election is going to be constant conflict and nothing getting done because there is no willingness to compromise. For those of us in the ASC industry, that means continued uncertainty at a time when we are already dealing with rising costs, staffing challenges and reimbursement that is not keeping up. It is difficult to plan for the future, hire staff or invest in your center when you don’t know what to expect from Washington. Even if Congress is unable to reach agreement, CMS will continue to move forward with regulatory changes that affect how we operate. That makes it all the more important for ASC leaders to stay informed and be prepared to adapt. Ultimately, this affects our ability to provide care, and that is what concerns me most.
Erin Hardwick. System Vice President of Ambulatory Surgery at CommonSpirit Health (Chicago): As reimbursement pressures mount, healthcare affordability remains a bipartisan priority. The future of surgery is increasingly outpatient, driven by fundamental shifts in healthcare economics and clinical innovation that transcend election cycles. Affordability and access will continue to accelerate growth, positioning ASCs and health systems to lead solutions to the cost conundrum through strategic physician alignment and intentional investment in ambulatory surgical platforms.
Raghu Reddy. Chief Administrative Officer of MiOrtho Surgery Center and a member of the Ambulatory Surgery Center Association’s Education and Quality Committees (Southfield, Mich.): The election results were predictable given the current state of the economy. For the ASC industry, I’d like to see three things advanced: site-neutral payment legislation, more accountability for commercial payers to keep reimbursement in line with inflation and rising care costs, and simpler prior authorization. CMS can do much of this on its own, but lawmakers should look at outpatient surgery as a whole and reward ASCs for the patient outcomes and cost savings they deliver. [The current] payment system works against what the nation needs: access, quality and savings.
David Uba. CEO of Excelsior Orthopedics (Amherst, N.Y.): With the election behind us, my hope is that healthcare affordability will create common ground for meaningful action. For independent, physician-owned centers like Buffalo Surgery Center, that means reimbursement that supports high-quality outpatient care, fewer unnecessary authorization barriers and policies that preserve competition and patient choice. Regardless of which party is in control, we need policymakers to recognize independent ASCs as part of the solution to rising healthcare costs and protect our ability to invest, innovate and remain independent.
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.
