Three-party ownership and in-house billing are among the trends ASC leaders said can help lead surgery centers to success.
Four ASC leaders answered the question: "What trend should ASCs jump on next to be successful?"
Editor's note: Responses were edited lightly for clarity and brevity.
Jeffrey Flynn. Administrator and COO of Gramercy Surgery Center (New York City): I believe it should be total bundles in payments with the insurance companies. The payers are now interested in discussing bundles on some of the higher spends that can be done in the outpatient setting. Joint replacements, bariatric and some general procedures are all on the table for discussion. With the bigger push to move procedures out of the hospital, many of us are in discussions for bundled payments with a boost in the reimbursement to bring it to the more cost-efficient setting. In some instances, there is an enhanced payment after three months if there was no readmission or emergency room visits. As we do more advanced procedures in the ASC setting due to technology progress, we should be focused on working with the payers to achieve a value-based health service and better outcomes.
Justin LeCompte. CEO of Virtuous Health Centers (Phoenix): Existing contracts and noncontracted payments need to be analyzed more thoroughly. Insurance companies want us to believe that ASCs are an important factor of healthcare savings, yet many of them have closed panels, at least in our market. Many of our centers are out of network and the benefit plans are worded in our favor based upon case selection. When all appeals have been exhausted and the legal battle begins, that's when the plan administrator decides to follow the language in their plan accordingly. The benefit of in-house billing will yield more transparency and supply the data needed to fight these cases successfully.
Craig Sarine. CEO of University Surgical Associates (Chattanooga, Tenn.): The largest ASC trend that I see emerging is one of ownership. Since the beginning of ASCs, ownership has gone through cycles of independent investors, individual and group physician practices, hospitals and every imaginable combination, often within the same facility. With insurance companies insisting on moving procedures out of the hospital, including HOPDs, hospitals are going to be hard pressed to simply let that revenue go, especially in their current low- to negative-margin environment.
I believe new creative structures will emerge that will include three-party ownership or participation (in the case of a hospital/physician venture managed by a third-party manager). The ASC company that perfects such a model will be successful going forward.
Mark Townsend, MD. Chief Clinical Officer of Providence Group at Bon Secours Mercy Health (Richmond, Va.): A trend that ASCs should jump on to be successful is empowering hospital-employed physicians to be equity owners and shareholders in ASCs. There is a compliant mechanism to do so while building in safeguards to prevent inducement of referrals. Including employed physicians as shareholders in ASCs gives them a "stake in the game" relative to efficiencies and operational throughput and incentivizes performance through the motivation that comes with shared ownership.