Here eight ambulatory surgery center administrators discuss healthcare reform and how it has affected their centers.
Q: What are the biggest changes that you have implemented in your ASC since the onset of healthcare reform? What changes are you still in the process of making?
Keith Smith, MD, Administrator, Surgery Center of Oklahoma (Oklahoma City). We have worked to eliminate leverage of all kinds from our practices. We have never taken federal money and this has insulated us from many of the requirements and regulations many facilities must endure. We have avoided managed care contracts as a rule and are seeking direct relationships with employers and third party administrators. Our online pricing has brought us individual patients from all over the country and Canada. All of this business resides outside of this new health law.
Bruce Kupper, CEO of MEDARVA Healthcare, Stony Point Surgery Center (Richmond, Va.). At this time, Medarva at Stony Point Surgery Center is still in a wait and see mode when it comes to healthcare reform. There are a lot of unknowns that we are waiting on, but we are trying to be proactive in some areas. We want our ASC to continue to be seen as a good value, low cost, high quality, provider of outpatient surgery services, which fits into the health reform model. This way we are seen as an essential part of a health insurance company's offerings. Under the current model of healthcare, surgeons are still generating revenue by seeing patients and operating or performing other procedures. Essentially, they are still on a productivity based model for pay, so as their reimbursement is being cut, by Medicare, commercial insurances and potentially with healthcare reform, the way they make up their lost income is to be able to do more surgeries, more efficiently. ASCs should continue to emphasize the turnover times and patient through-put in comparison to an acute care hospital.
Evalyn Cole, Spine Surgery Center of Eugene (Ore.). Meaningful use compliance is our largest concern. We thought we were compliant with the Quality Measures reporting requirements, but we were either misinformed or did not get complete information. So we had to apply for an “Extraordinary Circumstances Extension or Waiver," which we were granted and we were able to make required corrections. There are so many people and departments involved, with CMS and other federal payers and each contact person interprets guidelines differently; so it is hard to get a final answer.
Brooke A. Day, Administrator, Hastings (Neb.) Surgical Center. Political awareness has become a growing concern. Surgery centers need to develop at minimum a five year plan; it could determine whether or not your business survives. Hastings Surgical Center has a strategic planning committee consisting of four physicians that seek to reach the goals of the surgery center. The center is focusing on preparing physicians for ICD-10 changes, facilitating communication with providers and allowing providers to access the center's records electronically. ACOs may provide better coordinated care, but ASCs need to understand how their business will be affected. Two large ACOs have already formed in Nebraska, which is concerning for independent centers.
Steve Corl, administrator, Mackinaw Surgery Center (Saginaw, Mich.). We have been changing all along. For reform, one of the most important things is making sure to know who will be running ACOs and aligning ourselves with these organizations. It has been a challenge educating organizations, such as ACOs, about ASCs, but Michigan Ambulatory Surgery Association and ASCA have both stepped forward to work on this. Not many ACOs have formed in Michigan as of yet. We are holding off to see what happens with the new reforms. We have also had to take into consideration the transition to EHR. Our center will completely shift to EHR by July.
Karen C. Howey, CEO, administrator, Macomb (Mich.) Township ASC. We have begun to feel pressure to move towards an EHR system, but have yet to see much of an incentive. Our center is currently operating with paper records, which we are working on scanning into our system. We have to be aware of our current reimbursement rate and our existing budget does not allow for an entire shift to EHR. Our center is aware that challenges lay ahead in CMS compliance and volume fluctuation due to physicians moving towards hospital employment. Our biggest concern is how we will be affected by the changing physician landscape. In regards to ICD-10 compliance, we feel very confident. Our management company, Nueterra, has a program in place to address this issue. It is an arduous process, but we are certain we are where we should be.
Jeff Wigton, director of operations, Central Maine Orthopaedics (Auburn). One of the biggest changes we have faced is the transition to EHR. We met meaningful use last year, but we really had to change our whole model of care. Doing all of preoperative work in EHR required the addition of computers in every room and staffing changes. Our center learned to embrace the system and use it. Though we are still adapting to some aspects of EHR, it has not caused a problem from the standpoint of patient service. On the other hand, it has created a large work load on our end. There is a lot of data entry to be done. Right now we are just at the beginning of the ICD-10 process. We are waiting for our software vendors to show us how we will need to document. We understand what we will have to do, but we need the vehicle to do it. ICD-10 is more complex and time consuming than ICD-9 and we have had to add staff to handle the influx of work. Our center has had to undergo a great deal of restructuring.
Leslie Cottrell, administrator, Baptist Physicians Surgery Center (Lexington, Ky.). Our ASC has addressed cost and efficiency for over 10 years. Procedure volume has fluctuated based on physician alignment and to counteract the effect, we have recruited new physicians, specialties and performed procedures previously done as inpatient. To meet ongoing healthcare challenges, patient care providers' education and involvement are essential in cost containment efforts and efficiency practices. Contract negotiations and inventory management monitoring is ongoing and continues to be crucial in maintaining high quality provider status in our area. Physician office communication has increased to achieve pre-approvals, specific requests and patient information prior to the scheduled date of surgery. We are currently phasing an EMR system into our facility to better serve our patients through the healthcare continuum.
More Articles on ASC Issues:
When ACOs Come to Town: Q&A on Options for ASCs With Jon Friesen of Nueterra
How Does Sequestration Impact ASC Medicare Reimbursement?
5 Weekly Benchmarks for ASCs to Track
Q: What are the biggest changes that you have implemented in your ASC since the onset of healthcare reform? What changes are you still in the process of making?
Keith Smith, MD, Administrator, Surgery Center of Oklahoma (Oklahoma City). We have worked to eliminate leverage of all kinds from our practices. We have never taken federal money and this has insulated us from many of the requirements and regulations many facilities must endure. We have avoided managed care contracts as a rule and are seeking direct relationships with employers and third party administrators. Our online pricing has brought us individual patients from all over the country and Canada. All of this business resides outside of this new health law.Bruce Kupper, CEO of MEDARVA Healthcare, Stony Point Surgery Center (Richmond, Va.). At this time, Medarva at Stony Point Surgery Center is still in a wait and see mode when it comes to healthcare reform. There are a lot of unknowns that we are waiting on, but we are trying to be proactive in some areas. We want our ASC to continue to be seen as a good value, low cost, high quality, provider of outpatient surgery services, which fits into the health reform model. This way we are seen as an essential part of a health insurance company's offerings. Under the current model of healthcare, surgeons are still generating revenue by seeing patients and operating or performing other procedures. Essentially, they are still on a productivity based model for pay, so as their reimbursement is being cut, by Medicare, commercial insurances and potentially with healthcare reform, the way they make up their lost income is to be able to do more surgeries, more efficiently. ASCs should continue to emphasize the turnover times and patient through-put in comparison to an acute care hospital. Evalyn Cole, Spine Surgery Center of Eugene (Ore.). Meaningful use compliance is our largest concern. We thought we were compliant with the Quality Measures reporting requirements, but we were either misinformed or did not get complete information. So we had to apply for an “Extraordinary Circumstances Extension or Waiver," which we were granted and we were able to make required corrections. There are so many people and departments involved, with CMS and other federal payers and each contact person interprets guidelines differently; so it is hard to get a final answer. Brooke A. Day, Administrator, Hastings (Neb.) Surgical Center. Political awareness has become a growing concern. Surgery centers need to develop at minimum a five year plan; it could determine whether or not your business survives. Hastings Surgical Center has a strategic planning committee consisting of four physicians that seek to reach the goals of the surgery center. The center is focusing on preparing physicians for ICD-10 changes, facilitating communication with providers and allowing providers to access the center's records electronically. ACOs may provide better coordinated care, but ASCs need to understand how their business will be affected. Two large ACOs have already formed in Nebraska, which is concerning for independent centers. Steve Corl, administrator, Mackinaw Surgery Center (Saginaw, Mich.). We have been changing all along. For reform, one of the most important things is making sure to know who will be running ACOs and aligning ourselves with these organizations. It has been a challenge educating organizations, such as ACOs, about ASCs, but Michigan Ambulatory Surgery Association and ASCA have both stepped forward to work on this. Not many ACOs have formed in Michigan as of yet. We are holding off to see what happens with the new reforms. We have also had to take into consideration the transition to EHR. Our center will completely shift to EHR by July. Karen C. Howey, CEO, administrator, Macomb (Mich.) Township ASC. We have begun to feel pressure to move towards an EHR system, but have yet to see much of an incentive. Our center is currently operating with paper records, which we are working on scanning into our system. We have to be aware of our current reimbursement rate and our existing budget does not allow for an entire shift to EHR. Our center is aware that challenges lay ahead in CMS compliance and volume fluctuation due to physicians moving towards hospital employment. Our biggest concern is how we will be affected by the changing physician landscape. In regards to ICD-10 compliance, we feel very confident. Our management company, Nueterra, has a program in place to address this issue. It is an arduous process, but we are certain we are where we should be. Jeff Wigton, director of operations, Central Maine Orthopaedics (Auburn). One of the biggest changes we have faced is the transition to EHR. We met meaningful use last year, but we really had to change our whole model of care. Doing all of preoperative work in EHR required the addition of computers in every room and staffing changes. Our center learned to embrace the system and use it. Though we are still adapting to some aspects of EHR, it has not caused a problem from the standpoint of patient service. On the other hand, it has created a large work load on our end. There is a lot of data entry to be done. Right now we are just at the beginning of the ICD-10 process. We are waiting for our software vendors to show us how we will need to document. We understand what we will have to do, but we need the vehicle to do it. ICD-10 is more complex and time consuming than ICD-9 and we have had to add staff to handle the influx of work. Our center has had to undergo a great deal of restructuring. Leslie Cottrell, administrator, Baptist Physicians Surgery Center (Lexington, Ky.). Our ASC has addressed cost and efficiency for over 10 years. Procedure volume has fluctuated based on physician alignment and to counteract the effect, we have recruited new physicians, specialties and performed procedures previously done as inpatient. To meet ongoing healthcare challenges, patient care providers' education and involvement are essential in cost containment efforts and efficiency practices. Contract negotiations and inventory management monitoring is ongoing and continues to be crucial in maintaining high quality provider status in our area. Physician office communication has increased to achieve pre-approvals, specific requests and patient information prior to the scheduled date of surgery. We are currently phasing an EMR system into our facility to better serve our patients through the healthcare continuum.More Articles on ASC Issues:
When ACOs Come to Town: Q&A on Options for ASCs With Jon Friesen of Nueterra
How Does Sequestration Impact ASC Medicare Reimbursement?
5 Weekly Benchmarks for ASCs to Track