Saul Epstein, co-administrator of ParkCreek Surgery Center in Coconut Creek, Fla., makes four points on how ACOs could affect ambulatory surgery centers.
1. Role of ACOs is uncertain. The healthcare reform law is a target for repeal, and while those efforts focus on the individual mandate to buy insurance, it's hard to know how things will play out. "I have no clue what things are going to look like a year from now," Mr. Epstein says. "Things change by the month, it seems. You think you know how things are going, then the president changes his position, as he did on the Bush tax cuts."
2. ACOs will require significant outlays. To participate in ACOs, centers have to upgrade mechanisms to measure quality and cost. This will probably require an electronic medical record system, but EMR systems are expensive and ASCs will have to pay the full cost, because there is no federal "meaningful use" subsidy for ASCs, as there is for hospitals and practices. Given the uncertainty of healthcare reform, "there is as yet no business case for us to install an EMR," Mr. Epstein says. He is content to wait a little longer for vendors to create a "best of breed" system for ASCs.
3. Once ACOs start, things will move fact. With the start of Medicare ACOs a year away, private payors in Florida do not yet appear to be moving toward ACOs as they are in some other parts of the country. But once ACOs begin, surgery centers have to move fast to affiliate with one of them. "Those that don't are going to be left out in the cold," Mr. Epstein says.
4. ASCs might turn out to be cost centers. While ASCs are the low-cost, high-quality alternative for surgery, they may, strangely enough, turn out to be a cost center. Since ACOs will be incented to do less, they may try to push down the volume of surgery. "When an ACO is paid a lump sum for a patient's care, surgery will be seen as a cost center," Mr. Epstein says.
Learn more about ParkCreek Surgery Center.
Read more about accountable care organizations and ASCs:
- 7 Trends Likely to Impact the Future of ASCs
- Outlook for ASCs in 2011: From Andrew Hayek of the Ambulatory Surgery Center Advocacy Committee