Mark Mayo, executive director of the ASC Association of Illinois, discusses five issues that will shape the future of Illinois ASCs. Mr. Mayo has served as the association’s executive director for the past 21 years.
1. ASC Association of Illinois is working with the Illinois Department of Health to create an adverse event reporting mechanism. According to Mr. Mayo, Illinois has had a mechanism in place for several years requiring surgery centers and hospitals to report utilization data. The next phase of reporting will focus on adverse events and quality control, meaning the state should eventually have a system to benchmark ASCs against each other and provide a reference library on quality control for surgery center administrators.
"We proposed using adverse event root cause analysis reports to help educate providers by sharing improvement plans to the department of health at a time when the department was looking to increase ASC annual licensing fees in order to hire additional resources," Mr. Mayo says. The department backed a legislative proposal in 2010 to increase licensure fees from $300 to $1,500, a bill that did not pass over strong opposition from provider groups. "Rather than just look around at what centers were doing, we felt they needed to be more of a resource [to help centers improve]," Mr. Mayo says.
He says that though the reporting mechanism has yet to be rolled out, he doesn't foresee it posing a significant challenge to accredited surgery centers, which should already be addressing quality issues internally. He says data will be submitted electronically to the state and will remain anonymous, so that rather than target specific centers, the department of health will use the data to identify key issues and educate surgery centers on the best way to avoid or respond to adverse events.
2. ASCs are experiencing increased competition from hospitals and physician practices. Mr. Mayo says that as more hospitals merge or partner with each other, independent surgery centers may be excluded from physician referrals and see drops in patient volume. At the same, he says more Illinois physicians are attempting to perform surgical procedures in the office setting. Combined, the two trends lead to more competition for surgery centers, both in terms of recruiting physicians to the ASC and maintaining a healthy patient volume. Despite the competition, Mr. Mayo says he sees two significant opportunities for growth for Illinois ASCs:
3. Illinois single-specialty surgery centers are growing. Mr. Mayo says the ASC Association of Illinois has seen more state certificate of need approval of single-specialty surgery centers because they can make a persuasive case that the centers provide a service not routinely available at the hospital.
"[Single-specialty ASCs] have the ability to make that case more effectively to the CON board, and there's less opposition from the hospital because the ASC may specialize in an area that the hospital doesn't particularly cater to," he says. For example, an ASC that concentrates mainly on endoscopy procedures will face less competition from hospitals that focus on neurological, spine and orthopedic procedures.
"This trend mirrors what happened several years ago with ophthalmology surgery centers," he says. "The vast majority of cataract surgery is performed outside the hospital, and I see that trend expanding to include other surgical areas."
4. Case volumes for independent surgery centers have reached a plateau but remain strong. While other states see surgery centers increasingly partnering with hospitals or working with management companies, Mr. Mayo says the independent ASC model is still thriving in Illinois. He sees some expansion of the hospital/ASC joint-venture model because "facilities partner with an existing hospital to promote the relationship between the surgeons at the surgery center and the same surgeons at the hospital." The growth of management companies in Illinois, on the other hand, has been relatively slow in recent years as independent surgery centers find ways to address Medicare standards and national safety goals without the help of a management firm. "The model where 50 percent or more of the surgery center is owned by a management company has not taken hold here," Mr. Mayo says.
He predicts that if case volumes and reimbursements continue to decline, there will be more pressure on independent surgery centers to perform more efficiently — and in that case, the joint-venture and management-company models may be more attractive. But for now, he says independent surgery centers are surviving on their own. "Honestly, I have not seen very many hospital joint ventures where the surgery center receives a lot of the potential benefits the hospital could deliver, such as supply management and managed care contracting," he says.
5. ASC Association of Illinois is challenging an attempt to give the same workers' compensation facility reimbursements to physician offices as to ASCs. Mr. Mayo says the Illinois' Workers' Compensation Commission is currently proposing new regulations to authorize certain physician offices to receive the same full facility reimbursement as an ASC for the same procedure. He finds the move problematic for two reasons: First, the physician offices would not be required to undergo the same sanctions, licensing, CON process and oversight that all ASCs must address. Second, he says Illinois would not achieve any cost savings from offering physician offices the same facility fee, so the decision could negatively affect the state budget at a time when Illinois is in a severe financial crisis. The IWCC based its decision on the purported lack of access to surgery for Illinois residents, namely that hospitals are slow to provide services to workers' compensation patients. "I don't agree [that there is a lack of access], and I also don't agree with giving the same facility fee to a physician who isn't subject to the same standards and survey inspections," Mr. Mayo says.
In order to push back against the IWCC regulations, the ASC Association of Illinois has submitted testimony to the commission to challenge the rule. He remains hopeful about changing the decision, considering the Association's historically positive relationship with the IWCC. "We worked very well with the Commission on establishing the new rates a few years ago, but we were never consulted on this new proposed rule," he says. "We were really dismayed by that."
1. ASC Association of Illinois is working with the Illinois Department of Health to create an adverse event reporting mechanism. According to Mr. Mayo, Illinois has had a mechanism in place for several years requiring surgery centers and hospitals to report utilization data. The next phase of reporting will focus on adverse events and quality control, meaning the state should eventually have a system to benchmark ASCs against each other and provide a reference library on quality control for surgery center administrators.
"We proposed using adverse event root cause analysis reports to help educate providers by sharing improvement plans to the department of health at a time when the department was looking to increase ASC annual licensing fees in order to hire additional resources," Mr. Mayo says. The department backed a legislative proposal in 2010 to increase licensure fees from $300 to $1,500, a bill that did not pass over strong opposition from provider groups. "Rather than just look around at what centers were doing, we felt they needed to be more of a resource [to help centers improve]," Mr. Mayo says.
He says that though the reporting mechanism has yet to be rolled out, he doesn't foresee it posing a significant challenge to accredited surgery centers, which should already be addressing quality issues internally. He says data will be submitted electronically to the state and will remain anonymous, so that rather than target specific centers, the department of health will use the data to identify key issues and educate surgery centers on the best way to avoid or respond to adverse events.
2. ASCs are experiencing increased competition from hospitals and physician practices. Mr. Mayo says that as more hospitals merge or partner with each other, independent surgery centers may be excluded from physician referrals and see drops in patient volume. At the same, he says more Illinois physicians are attempting to perform surgical procedures in the office setting. Combined, the two trends lead to more competition for surgery centers, both in terms of recruiting physicians to the ASC and maintaining a healthy patient volume. Despite the competition, Mr. Mayo says he sees two significant opportunities for growth for Illinois ASCs:
- Increased patient loads resulting from universal coverage. "More individuals who are now just obtaining coverage by insurance changing coming into effect under the new health care reform law will seek treatment for pre-existing conditions and other conditions they may not have been able to get coverage for," he says. Because many individuals receiving health insurance for the first time may not be used to contacting and using a healthcare provider, he says ASCs must prepare to build relationships with referring primary care physicians.
"We need to provide information to those primary care physicians who feed cases into surgical practices," he says. "I see that as a way to grow interest in surgery centers, and I think it's an excellent opportunity to partner with physicians." Encouraging physicians who work at the surgery center to build their relationships with other physicians will help direct more newly insured patients to ASCs, Mr. Mayo says.
- Surgeons from group practices joining the staff of ASCs. As surgeons expand their practices by bringing in partners or new medical staff members, there may be more opportunity for those providers to cover both the hospital and the surgery center. ASCs should be instrumental in helping physician group practices meet the diverse needs of their patients. "The growth of practices into group practices doesn't preclude members of those practices to be on staff of the surgery center," Mr. Mayo says. "It's an opportunity to educate existing ASC surgeons on expanding the reach of their group practice."
3. Illinois single-specialty surgery centers are growing. Mr. Mayo says the ASC Association of Illinois has seen more state certificate of need approval of single-specialty surgery centers because they can make a persuasive case that the centers provide a service not routinely available at the hospital.
"[Single-specialty ASCs] have the ability to make that case more effectively to the CON board, and there's less opposition from the hospital because the ASC may specialize in an area that the hospital doesn't particularly cater to," he says. For example, an ASC that concentrates mainly on endoscopy procedures will face less competition from hospitals that focus on neurological, spine and orthopedic procedures.
"This trend mirrors what happened several years ago with ophthalmology surgery centers," he says. "The vast majority of cataract surgery is performed outside the hospital, and I see that trend expanding to include other surgical areas."
4. Case volumes for independent surgery centers have reached a plateau but remain strong. While other states see surgery centers increasingly partnering with hospitals or working with management companies, Mr. Mayo says the independent ASC model is still thriving in Illinois. He sees some expansion of the hospital/ASC joint-venture model because "facilities partner with an existing hospital to promote the relationship between the surgeons at the surgery center and the same surgeons at the hospital." The growth of management companies in Illinois, on the other hand, has been relatively slow in recent years as independent surgery centers find ways to address Medicare standards and national safety goals without the help of a management firm. "The model where 50 percent or more of the surgery center is owned by a management company has not taken hold here," Mr. Mayo says.
He predicts that if case volumes and reimbursements continue to decline, there will be more pressure on independent surgery centers to perform more efficiently — and in that case, the joint-venture and management-company models may be more attractive. But for now, he says independent surgery centers are surviving on their own. "Honestly, I have not seen very many hospital joint ventures where the surgery center receives a lot of the potential benefits the hospital could deliver, such as supply management and managed care contracting," he says.
5. ASC Association of Illinois is challenging an attempt to give the same workers' compensation facility reimbursements to physician offices as to ASCs. Mr. Mayo says the Illinois' Workers' Compensation Commission is currently proposing new regulations to authorize certain physician offices to receive the same full facility reimbursement as an ASC for the same procedure. He finds the move problematic for two reasons: First, the physician offices would not be required to undergo the same sanctions, licensing, CON process and oversight that all ASCs must address. Second, he says Illinois would not achieve any cost savings from offering physician offices the same facility fee, so the decision could negatively affect the state budget at a time when Illinois is in a severe financial crisis. The IWCC based its decision on the purported lack of access to surgery for Illinois residents, namely that hospitals are slow to provide services to workers' compensation patients. "I don't agree [that there is a lack of access], and I also don't agree with giving the same facility fee to a physician who isn't subject to the same standards and survey inspections," Mr. Mayo says.
In order to push back against the IWCC regulations, the ASC Association of Illinois has submitted testimony to the commission to challenge the rule. He remains hopeful about changing the decision, considering the Association's historically positive relationship with the IWCC. "We worked very well with the Commission on establishing the new rates a few years ago, but we were never consulted on this new proposed rule," he says. "We were really dismayed by that."