While CMS has made some policies directing surgeries to ASCs, it has also developed regulations ASC leaders see as unnecessary obstacles to outpatient procedure migration.
Ten ASC leaders spoke with Becker's ASC Review on the CMS changes they would like to see to benefit ASCs and patient care.
Editor's note: These responses were edited lightly for clarity and brevity.
1. Enhanced data collection
Simon Chao, MD. Orthopedic surgeon at University Orthopedics (Easton, Mass.): I think one addition that CMS could implement would be to enhance data collection — tracking patient outcomes, specifically regarding infection rates, readmission rates, reoperation rates and overall complication rates. CMS has the benefit of having a large pool of potential data involving a cross-section of individuals. This could overall improve patient outcomes in ASC settings.
2. Diminished bureaucratic burdens
Eduardo Tolentino, Administrator of the Outpatient Surgery Center of Central Florida (Wildwood): Bureaucratic burden is always bad for business, as it negatively impacts the operation in multiple aspects. Don’t get me wrong, regulation is important for quality and safety reasons, but over-regulation creates unnecessary stress on the already complicated healthcare system.
3. Expanded CMS-covered procedures in ASCs
Vipul Nanavati, MD. Orthopedic surgeon at Idaho Shoulder to Hand Specialists (Boise): I believe we have transcended the need for hospital-based surgeries in many of the surgeries we do in the hospital-based setting, especially those that generally require no more than a 23-hour observation status. A particular example is total shoulder arthroplasty surgeries. The techniques, tools, surgical skills and time for surgery are now more akin to shoulder arthroscopic repair procedures in 2021. It would be nice to see Medicare be more responsive in releasing procedures across surgical specialties that can be done in the ASC setting in a more cost-effective and efficient manner. I believe CMS needs to be more responsive in expanding the list of CMS-covered procedures to the changing landscape of surgical procedures as their efficiency and efficacies are being proven in the ASC setting.
Matthew Ornelas. Administrator at Shields Health Care Group (Boston): CMS should include more codes for ASC reimbursement. We are forced to send outpatient procedures to the hospital because CMS does not recognize certain codes for the ASC. If the patient is healthy enough and fits the parameters, why are they forced to go to a high-cost facility for nonspecialized care?
Darin Hill. CEO of Compass Surgical Partners: The movement to site-neutral care, whereby reimbursement would be consistent between hospital outpatient departments and ASCs, will create massive benefits for patients, providers and payers.
Crystal Livingston, RN. Administrator of Doctors Outpatient Surgery Center (Lincoln, Neb.): CMS should increase the number of procedures allowed in the ASC vs. the HOPD. The loss of these CPT codes back to the HOPD will negatively affect business, but most importantly, it negatively affects the patient. These procedures can be safely performed in the ASC with similar, if not better, outcomes and at a fraction of the cost to the patient and to CMS.
Gil Tepper, MD. Founder and CEO of Prime Surgeons (Los Angeles): Surgery centers, as small businesses, are clearly beneficial to the system — the success of ambulatory surgery as a discipline is critical to the benefit of the healthcare system in offloading the hospitals for more critical care. Today, the playing field is not level with reimbursement calculations using different indices between the outpatient department and the ASC — hospitals being reimbursed higher. This is a product of unfair and uneven lobbying size — with hospitals having much more representation on the lobbying side.
4. More price transparency
Laurence Rosenberg, MD. Plastic surgeon at Southeastern Plastic Surgery (Tallahassee, Fla.): All healthcare costs should be transparent, including provider, hospital, ASC, etc.
5. No medical history requirements
Stephen Uretsky, MD. Ophthalmologist at Coastal Jersey Eye Center (Linwood, N.J.): CMS should revise or eliminate the requirement for a medical history and physical before surgery in an ASC for patients undergoing minimally invasive surgical procedures, including cataract surgery, eye lasers, etc. There is extensive peer-reviewed literature to support the lack of benefit to patients of this requirement. Patients view having to see their primary care doctors for this purpose as inconvenient and a waste of time. Most primary care practitioners, in my experience, believe there is no value for the patient in undergoing testing or examinations preoperatively.