Impact of November Elections on ASCs: Q&A With Andrew Hayek of the Ambulatory Surgery Center Advocacy Committee

Andrew Hayek is chair of the Ambulatory Surgery Center Advocacy Committee and president and CEO of Surgical Care Affiliates.

Q: What do you predict as the outcome of the November elections?

Andrew Hayek: It appears that there is a lot of momentum for the Republicans to potentially take control of the House. It is significantly less likely that they will take control of the Senate.

Q: What would this outcome mean for the healthcare reform bill?

AH: The notion of repealing the healthcare reform bill is extremely unlikely. It would have to be done over a Presidential veto, and with the Republicans most likely not controlling the Senate, getting to a 60-vote veto override will be very unlikely. There is a nuclear option — since the spending bills originate in the House, the House could say we don't want to fund any of the healthcare reform bill, but I think that is highly unlikely.

I do think Congress will have a robust discussion around the bill and its major components, and there will likely be a lot of discussing and investigation in the House, presuming that the Republicans take control of the House. As to what actually gets modified in the bill is an entirely different question that is very difficult to address. On the whole, I think the bill stays intact at least until the presidential election in two years.

Q: Under the scenario where you have a Republican-controlled House and Democratic-controlled Senate and White House, what does that mean for ASCs?

AH: We have a lot of ground to cover on both sides of the aisle in educating people about ASCs and the value we provide. With the ongoing discussions in Congress about addressing the rapidly increasing Federal deficit and rising health care costs, ASCs provide real cost-savings for patients, providers and the entire health care system, along with outstanding patient care and convenience. This is the message we want to share with Congress and the Administration regardless of which party holds the majority.

Q: If the Republicans do not capture the House, what might that scenario mean for the surgery center industry?

AH: Regardless if Republicans or Democrats have control of the House following the mid-term elections, we as an industry still have a lot of work to do to educate our Congressional leaders about ASCs and the value we provide to the health care system. Our main concern with the healthcare reform bill is that the "productivity adjustment" mechanism, which deducts an estimate for general labor productivity improvement in the general economy from annual updates for most healthcare providers (including hospitals and ASCs), results in approximately zero rate growth for ASCs in the future. This will impact ASCs ability to continue providing patient-centered care to millions, given that costs are growing each year but reimbursement won't.

Also, the House-passed version of reform would have required ASC cost reporting, a provision that would be very burdensome to the industry, especially independent ASCs, which is one reason why CMS is against cost reporting for ASCs. While the bill ultimately did not include cost reporting, the issue could re-emerge in the future.

Additionally, because the healthcare reform bill will likely cost much more than originally estimated (which has been the pattern of almost every major healthcare initiative) and because the Federal deficit will remain a significant long-term problem for our government, I remain concerned about future rate cuts for all healthcare providers, including ASCs and physicians. We have a significant financial problem as a country, given the size of our debt and deficit, and the healthcare reform bill added an enormous additional financial burden on our government — a burden that will almost certainly be bigger than originally estimated. This is concerning as a member of the ASC community and as a tax payer.

Q: If the elections are not likely to significantly impact ASCs, what are the next steps for the industry?

AH: Regardless of who controls the House or the Senate or the presidency, we, as a country, still face a massive fiscal deficit and as an industry, ASCs will continue to feel the pressure from inequities in the Medicare payment system. Regardless of which party is in control of Congress, there's still going to be significant cost pressure on hospitals, on pharmaceutical companies, managed care plans, and on all providers of care.

Most of what we do doesn't change based on which political party is in control in the House. Our message continues to be that if you want to improve healthcare and if you want to lower costs in the system, then you need to shift more cases into the high-quality, low-cost setting that surgery centers provide. That's going to be an important theme that plays out in the government over the next several decades. When you look at the fiscal pressures of the health care system and the need to control cost growth, ASCs are a terrific part of the solution.

We're still going to need to be more active than ever on Capitol Hill — explaining our story and sharing data. We need more facilities to participation in the ASC Association and its activities, and we need to build our political fundraising. Right now our political fundraising as an industry is very small compared to other segments of healthcare providers. We need to build our network of grassroots champions who get to know members of Congress and, we need to continue to work collectively with our local ASCs, and the state and national associations to advance this national effort.

I was just at California's association meeting and it was terrific. The 250 ASC leaders in the room were energized and excited. They have done a great job engaging their Federal lawmakers this year, and they are eager to do more to leverage their relationships. I have had similar experiences in many other states, and this is what we are trying to build across the country.

Q: What other issues should the industry focus on to play up the benefits of ASCs?

AH: We need to continue to showcase the benefits of physician ownership in areas like clinical quality and efficiency. When physicians lead surgery facilities, they can play a vital role in ensuring outstanding patient care and in making decisions that improve cost efficiency, like choosing the most cost effective supplies and helping to create efficient schedules..

The healthcare reform bill emphasizes physicians collaborating with hospitals, and we believe that surgery centers exemplify the best elements of physician collaboration We need to, in a very positive way; point out this is a terrific example of where we want to take healthcare, which is tying physicians to the cost and efficiency of their facility just as they're trying to do in hospital setting.

We have enormous talent and possibility as an industry, and we are providing an outstanding service to the healthcare industry — the highest quality of patient care delivered in a lower-cost setting. Our power lies in building our grassroots network across every state and being targeted and consistent in our messaging. I think as we can more fully realize how to effectively coordinate our efforts, we will vastly improve how we communicate our important message on Capitol Hill and we will help ensure a strong future for ASCs on behalf of our patients, our physicians, and the entire healthcare system.

Visit the ASCAC website to learn more about the Ambulatory Surgery Center Advocacy Committee and how you can get involved or contact Andrew Hayek directly at

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