Ambulatory Surgical Centers of America Co-Founder Brent Lambert, MD, discusses why standalone ambulatory surgery centers have a bright future in the wake of healthcare reform. 1. Physicians want to be independent. Hospitals rushed to employ physicians over the past few years, but now are running out of money and ideas to incentivize productivity. Employed surgeons are also tired of taking direction from hospital administrators and will be ready to strike out on their own again when their contract comes due.
"What I see happening is that hospitals are going to find that you have to have incentive models for physicians, and some physicians won't like the incentives so they'll go back to practicing in the community outside of hospital employment," says Dr. Lambert. "Additionally, hospitals will realize they can't afford all their specialists and cut some loose. We are already seeing fault lines in this landscape."
Those who do return to independence will become potential investors for the center, or at least open to performing cases there.
2. ASCs continue to provide high quality, low cost care. Ambulatory surgery centers are uniquely positioned to meet the goals of high quality, low cost care in today's evolving healthcare marketplace. The quality value they hold includes:
• Lower infection rates
• Specialization, which reduces complication risk
• Knowledgeable, focused staff members
• Efficient OR processes
"The quality of care improves and surgery centers see better results because complications and infections are low," says Dr. Lambert. "These are also patients who are admitted for an elective procedure, so there isn't bacteria floating around the ASC like there is in a hospital. ASCs can meet the needs of these elective surgical patients and hospitals take really good care of people who have other medical problems and are very sick."
Price transparency in healthcare continues to increase and patients with high deductible plans will search for the low-cost setting. Self-employed companies and people with health savings accounts will also keep their eye on pricing, and emerging shared savings programs could be a great opportunity for ASCs to attract new patient volume in the future.
3. Plan for higher acuity cases moving to the ASC. Technology and anesthesia management has evolved to the point where some higher acuity cases, such as joint replacements, can be performed safely in the outpatient setting. If insurance companies believe they can achieve a lower rate while maintaining clinical quality in the ASC, more cases will be migrating that way in the future.
"Medicare doesn't pay for it yet, but I think they are only a few years away from that because it will cost half as much as performing the case in the hospital and with the same results or better because of advances in surgical techniques," says Dr. Lambert.
Some private payers are already reimbursing for total joint replacements in surgery centers, and some are even looking for ASCs to take on outpatient joint replacements for the appropriate patients as a less expensive alternative to the hospital.
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