Chris Squire, board member of Minnesota Ambulatory Surgery Center Association and its government relations committee chairman, discusses five issues affecting Minnesota ASCs.
1. MNASCA is working with legislators to increase awareness of ASC issues. As legislation on regulatory issues and reimbursement challenges continue to affect ASCs, Mr. Squire says MNASCA — along with the national ASC Association — is taking responsibility for communicating with legislators about ASC issues. "A lot of it's about education and getting legislators to understand how the healthcare delivery system works," he says. "We're letting them know what our challenges are and how regulatory burdens can add cost without bringing many substantive changes."
He says one of the challenges in dealing with legislators is that the origin of legislation can be confusing. Legislation affecting healthcare may come from a finance committee rather than a healthcare committee, meaning the people who originally drafted the legislation may not be connecting directly with healthcare facilities. "[Finance committees] can be myopic in their approach," Mr. Squire says. "They look to see which area they can pull additional revenue from, and there's no consideration of how that cut impacts payrolls and delivery and patient care."
2. Infection control guidelines need to be interpreted before they can be followed. Like many other states, Minnesota is preparing its ASCs for oncoming changes to infection control regulations — regulations that will likely put financial pressure on ASCs. Mr. Squire says as the state department of health becomes more involved in enforcing infection control standards, ASCs must work with the state government to interpret guidelines and encourage mutual education. "We need to get on the same page as to the expectations for current regulatory guidelines," he says. "If we have to report infection data within 30 days, [the state needs to understand] we're very dependent on physicians to report back data when we request it."
Careful interpretation of guidelines is essential for ASCs that will struggle financially because of stricter standards and reporting guidelines, Mr. Squire says. Many smaller ASCs struggle to find staff who can take responsibility for infection control oversight, and the implementation of software to report data is expensive. Before ASCs spend money on staffing and technology to improve infection control programs, administrators need to understand the state's expectations.
3. Value of ASCs is wasted when payors fail to reimburse for implants. In many states, including Minnesota, ASCs are forced to send orthopedic cases to the hospital when the implant proves too expensive for the case to be financially viable. As reimbursements decrease, expensive implants can force multi-specialty surgery centers to turn away the majority of their orthopedics cases — cases which could performed at a lower cost in an outpatient setting, Mr. Squire says. "No one [in the ASC community] feels the need to net substantial profit on procedures with high-end medical supplies or implants, but we need to break even," he says. "If you're talking about $2,000-$5,000 implants — and that's nothing in the orthopedic world — you can't eat those costs."
He says it "flies in the face of reason" to force those orthopedic cases out of the ASC setting. "Our hospital partners are great facilities, but for the more elective cases that can be done in an outpatient environment, we provide quality care and high patient satisfaction, and we can move cases in and out in a much more cost-effective way," he says. "To not get reimbursed seems counter-productive." Unfortunately, without a reverse to declining reimbursements from the federal government and commercial payors, the rejection of some orthopedic cases is inevitable for financially strapped ASCs.
4. Cutting ASC salaries is not viable in the current economy. The two largest expenses to ASCs are medical supplies and medical staff compensation and benefits, Mr. Squire says. Therefore, when faced with declining reimbursements, most ASCs look to their staff and supply budget to make cuts. But in the current economic and social environment, Mr. Squire says Minnesota ASCs are reticent to cut staff salaries unless "absolutely necessary" to the center's existence. "That's something that isn't on the table unless an individual facility absolutely has to do it," he says. He adds that the success of the current economy is in part driven by well-paid healthcare professionals. "We'd hate to put them out of a job," he says.
5. ASCs are struggling to survive without a health system or hospital affiliation. According to Mr. Squire, the biggest challenge currently facing Minnesota ASCs is decreased revenue. He says the 32 facilities involved with MNASCA "run the gamut" in terms of size and ownership model, but in his experience, "it's becoming increasingly difficult to survive without a system or hospital affiliation." Because hospitals and health systems have access to better managed care contracts and better GPO leverage, many ASCs are considering the move toward joint ventures.
Learn more about MNASCA.
1. MNASCA is working with legislators to increase awareness of ASC issues. As legislation on regulatory issues and reimbursement challenges continue to affect ASCs, Mr. Squire says MNASCA — along with the national ASC Association — is taking responsibility for communicating with legislators about ASC issues. "A lot of it's about education and getting legislators to understand how the healthcare delivery system works," he says. "We're letting them know what our challenges are and how regulatory burdens can add cost without bringing many substantive changes."
He says one of the challenges in dealing with legislators is that the origin of legislation can be confusing. Legislation affecting healthcare may come from a finance committee rather than a healthcare committee, meaning the people who originally drafted the legislation may not be connecting directly with healthcare facilities. "[Finance committees] can be myopic in their approach," Mr. Squire says. "They look to see which area they can pull additional revenue from, and there's no consideration of how that cut impacts payrolls and delivery and patient care."
2. Infection control guidelines need to be interpreted before they can be followed. Like many other states, Minnesota is preparing its ASCs for oncoming changes to infection control regulations — regulations that will likely put financial pressure on ASCs. Mr. Squire says as the state department of health becomes more involved in enforcing infection control standards, ASCs must work with the state government to interpret guidelines and encourage mutual education. "We need to get on the same page as to the expectations for current regulatory guidelines," he says. "If we have to report infection data within 30 days, [the state needs to understand] we're very dependent on physicians to report back data when we request it."
Careful interpretation of guidelines is essential for ASCs that will struggle financially because of stricter standards and reporting guidelines, Mr. Squire says. Many smaller ASCs struggle to find staff who can take responsibility for infection control oversight, and the implementation of software to report data is expensive. Before ASCs spend money on staffing and technology to improve infection control programs, administrators need to understand the state's expectations.
3. Value of ASCs is wasted when payors fail to reimburse for implants. In many states, including Minnesota, ASCs are forced to send orthopedic cases to the hospital when the implant proves too expensive for the case to be financially viable. As reimbursements decrease, expensive implants can force multi-specialty surgery centers to turn away the majority of their orthopedics cases — cases which could performed at a lower cost in an outpatient setting, Mr. Squire says. "No one [in the ASC community] feels the need to net substantial profit on procedures with high-end medical supplies or implants, but we need to break even," he says. "If you're talking about $2,000-$5,000 implants — and that's nothing in the orthopedic world — you can't eat those costs."
He says it "flies in the face of reason" to force those orthopedic cases out of the ASC setting. "Our hospital partners are great facilities, but for the more elective cases that can be done in an outpatient environment, we provide quality care and high patient satisfaction, and we can move cases in and out in a much more cost-effective way," he says. "To not get reimbursed seems counter-productive." Unfortunately, without a reverse to declining reimbursements from the federal government and commercial payors, the rejection of some orthopedic cases is inevitable for financially strapped ASCs.
4. Cutting ASC salaries is not viable in the current economy. The two largest expenses to ASCs are medical supplies and medical staff compensation and benefits, Mr. Squire says. Therefore, when faced with declining reimbursements, most ASCs look to their staff and supply budget to make cuts. But in the current economic and social environment, Mr. Squire says Minnesota ASCs are reticent to cut staff salaries unless "absolutely necessary" to the center's existence. "That's something that isn't on the table unless an individual facility absolutely has to do it," he says. He adds that the success of the current economy is in part driven by well-paid healthcare professionals. "We'd hate to put them out of a job," he says.
5. ASCs are struggling to survive without a health system or hospital affiliation. According to Mr. Squire, the biggest challenge currently facing Minnesota ASCs is decreased revenue. He says the 32 facilities involved with MNASCA "run the gamut" in terms of size and ownership model, but in his experience, "it's becoming increasingly difficult to survive without a system or hospital affiliation." Because hospitals and health systems have access to better managed care contracts and better GPO leverage, many ASCs are considering the move toward joint ventures.
Learn more about MNASCA.