At the 20th Annual Surgery Centers Conference on Oct. 25, industry experts shared insight on the current ASC industry and predictions for 2014.
Pulitzer Prize winner and Editor of The Washington Post Bob Woodward moderated the panel lead by Nap Gary, COO of Regent Surgical Health; Richard Wohns, MD, JD, MBA, of NeoSpine; I. Naya Kehayes, MPH, of Eveia Health Consulting and Management and Scott Becker, JD, CPA, partner of McGuireWoods.
Mr. Woodward opened the session by asking the panel to weigh in one of the biggest issues in healthcare: the Patient Protection and Affordable Care Act. Dr. Wohns pointed out that physicians will see a volume increase in the patient pool, including a great amount of patients being directed to ASCs. There is particularly a growing opportunity for spine in the outpatient setting, including procedures such as discectomies and fusions. "I think we are on the right track, but we are missing a lot of foundation," said Dr. Wohns.
Though ambulatory surgery centers continually prove to be safe and cost-effective alternatives to hospitals, there is uncertainty whether or not the federal government understands these advantages. Medicare reimbursement for ASCs in comparison to reimbursement for hospital outpatient departments has been declining for years. ASCs now receive 58 cents per every dollar that hospitals receive. Yet, ASCs are poised to save Medicare $57.6 billion over the next decade. "In an era when the focus is on improved quality and cost savings, ASCs stand as a real model," said Mr. Gary.
"We need to look at how Medicare sets the bar for approved procedures and reimbursement with commercial payers," said Ms. Kehayes. She recommends ASC leaders advocate for the industry and call for a change in the list of procedures allowed in ASCs and for change in how procedures are reimbursed. ASCs can demonstrate excellent patient satisfaction and quality outcomes, both of which can serve as leverage to change reimbursement rates from both government and commercial payers. "The floodgates won't really open until Medicare approves these goals," said Mr. Becker.
Hospitals are focused on acquiring physicians and physician groups and there are fewer physicians entering the medical field. The healthcare world is poised to experience a drastic shortage of physicians. "We will begin to see the ramifications of this shortage. It will affect ASCs. We are dependent on the number of physicians," said Mr. Gary.
Not only will ASCs feel the pinch, all healthcare providers have potential for impact. "The costs of healthcare go up at the end of someone's life. As the patient population continues to get older, it will be harder to get access," said Ms. Kehayes. Patients will struggle to find providers and providers will struggle to adequately handle the influx of patients that need care.
Consolidation continues to sweep healthcare, affecting the smallest ASCs and the largest networks. "When networks get too big, competition becomes difficult. With consolidation, this decreases free market competition," said Ms. Kehayes.
The number of challenges in healthcare is not small, but standing alongside these challenges are opportunities. ASC industry advocates are fighting to demonstrate the value surgery centers have to offer and create better opportunities for centers to provide patients with this value. "ASCA is exploring Medicare funding for spine and total hip replacement in the ASC setting," said Mr. Gary.
ASCs that are able to adapt to the impending changes will not only survive, but thrive. "We are getting more and more referrals. We offer bundled pricing. This is an opportunity to shine," said Dr. Wohns.
"There are big clouds on the horizon, but smaller than in the past few years," said Mr. Becker. "It is more of an economic war, but I am optimistic. ASCs need to be low cost and remain lean."
Pulitzer Prize winner and Editor of The Washington Post Bob Woodward moderated the panel lead by Nap Gary, COO of Regent Surgical Health; Richard Wohns, MD, JD, MBA, of NeoSpine; I. Naya Kehayes, MPH, of Eveia Health Consulting and Management and Scott Becker, JD, CPA, partner of McGuireWoods.
Mr. Woodward opened the session by asking the panel to weigh in one of the biggest issues in healthcare: the Patient Protection and Affordable Care Act. Dr. Wohns pointed out that physicians will see a volume increase in the patient pool, including a great amount of patients being directed to ASCs. There is particularly a growing opportunity for spine in the outpatient setting, including procedures such as discectomies and fusions. "I think we are on the right track, but we are missing a lot of foundation," said Dr. Wohns.
Though ambulatory surgery centers continually prove to be safe and cost-effective alternatives to hospitals, there is uncertainty whether or not the federal government understands these advantages. Medicare reimbursement for ASCs in comparison to reimbursement for hospital outpatient departments has been declining for years. ASCs now receive 58 cents per every dollar that hospitals receive. Yet, ASCs are poised to save Medicare $57.6 billion over the next decade. "In an era when the focus is on improved quality and cost savings, ASCs stand as a real model," said Mr. Gary.
"We need to look at how Medicare sets the bar for approved procedures and reimbursement with commercial payers," said Ms. Kehayes. She recommends ASC leaders advocate for the industry and call for a change in the list of procedures allowed in ASCs and for change in how procedures are reimbursed. ASCs can demonstrate excellent patient satisfaction and quality outcomes, both of which can serve as leverage to change reimbursement rates from both government and commercial payers. "The floodgates won't really open until Medicare approves these goals," said Mr. Becker.
Hospitals are focused on acquiring physicians and physician groups and there are fewer physicians entering the medical field. The healthcare world is poised to experience a drastic shortage of physicians. "We will begin to see the ramifications of this shortage. It will affect ASCs. We are dependent on the number of physicians," said Mr. Gary.
Not only will ASCs feel the pinch, all healthcare providers have potential for impact. "The costs of healthcare go up at the end of someone's life. As the patient population continues to get older, it will be harder to get access," said Ms. Kehayes. Patients will struggle to find providers and providers will struggle to adequately handle the influx of patients that need care.
Consolidation continues to sweep healthcare, affecting the smallest ASCs and the largest networks. "When networks get too big, competition becomes difficult. With consolidation, this decreases free market competition," said Ms. Kehayes.
The number of challenges in healthcare is not small, but standing alongside these challenges are opportunities. ASC industry advocates are fighting to demonstrate the value surgery centers have to offer and create better opportunities for centers to provide patients with this value. "ASCA is exploring Medicare funding for spine and total hip replacement in the ASC setting," said Mr. Gary.
ASCs that are able to adapt to the impending changes will not only survive, but thrive. "We are getting more and more referrals. We offer bundled pricing. This is an opportunity to shine," said Dr. Wohns.
"There are big clouds on the horizon, but smaller than in the past few years," said Mr. Becker. "It is more of an economic war, but I am optimistic. ASCs need to be low cost and remain lean."