Here are 10 predictions for ASCs in 2015.
1. It will be important for ASCs to ensure thy have access to patients and physicians. Physicians coming out of training are still signing hospital employment contracts at a high rate and consolidation remains an alarming trend in the industry. "It will be important for ASCs to prepare now for this continual change in the marketplace," says ASD Management Founding and Managing Partner Joe Zasa.
2. The best opportunities for ASC growth next year are in higher acuity cases. ASCs will reap the biggest benefits from adding new specialties such as cardiology — pacemakers and defibrillators — and spine surgery, says Mr. Zasa. Technology is now making it easier to bring these cases into the outpatient setting and ASCs are eager to create programs around profitable procedures.
3. Primary care physician employment will remain challenging, says Ambulatory Surgical Center of America Chief Development Officer Jeff Peo. "With the increase in employment of primary care practices by hospitals, many surgeons are feeling they can't take the cases to the location of their choice without putting their referral network at risk," says Mr. Peo. The case volume reduction is tied to less revenue and profit. As a result, some centers are looking into new staffing models, compressed schedules and modified hours to keep the ASC open.
4. There will be more patients with high deductible health plans, in narrow networks and with health insurance exchange plans. Patients will pay more out-of-pocket with these plans, and as they become more common, patient collections will be a bigger concern for ASCs. "Patients are putting off surgery because their deductibles are significantly higher than they have been in the past," says Mr. Peo. "This reduction in volume is putting significant financial pressure on many centers across the country."
5. The number of ASCs in the United States has flattened over the past few years, and some centers are seeking formal and informal alignment with hospitals — or joint ventures with management companies — to weather the storm. "Some ASCs will open and some will close next year," says Mr. Zasa. "We will continue to see joint ventures and expect 2015 to be similar to 2014 in terms of activity."
6. There will likely be fewer independent physicians, and competition for their business could become fierce in some markets. "This trend will likely last a few more years," says Mr. Zasa. "While not a popular opinion, I believe that the trend will reverse in the next few years as physicians desire to be more independent and control their hours and ways to deliver care."
7. ASCs will work more closely with hospitals. Traditionally, that relationship has been adversarial, but hospitals are looking for expertise in outpatient efficiency and quality care while ASCs are looking for larger organization partners to help secure their future. The healthcare system is also moving more toward coordinated care. "I think the ASC industry is strong, but in order to secure payers it will have to invest in [short stay] or work in partnership with a hospital, because even though healthcare technology is driving procedures toward the outpatient setting, payers will stay behind otherwise," says Jack Jensen, MD, FACSM, an orthopedic surgeon at Houston-based Athletic Orthopedics & Knee Center.
8. The trend toward price transparency could benefit ASCs if they are already the low-cost, high quality provider in the market. Some ASCs have already started targeting cash pay patients, self-insured employers and patients with health savings accounts to attract business locally and nationally. Many centers offering global payments with prices published online have received media attention for taking this step.
9. Bundled payments will become more popular at ASCs. While some hospitals have struggled to find the right bundled payment rate and negotiate which patients will be included in the bundle, ASCs have been more successful. When centers can control costs and deliver quality outcomes, their rates will be attractive to self-pay patients as well as insurers looking for partnership on new payment models.
10. Despite the extended ICD-10 implementation deadline to Oct. 1, 2015, many ASCs will still have difficulty with the transition. Medical coders and surgeons need training on the new reporting requirements, and the sudden transition could slow claims processing both at the ASC and for the insurer. As a result, some ASC owners are saving now to make sure their centers "weather the storm" next October.