Industry experts weigh in on the future of the ASC industry.
1. ASC joint ventures will increase. As ASCs continually struggle to survive against decreasing reimbursements, David Shapiro, MD, partner in Ambulatory Surgery Company, predicts the number of hospital/ASC joint ventures and other joint-venture models will increase. "If we don't bend the cost curve on the way ASCs get reimbursed, many are going to cease to be able to provide services," he said. "So they're going to have to migrate over to affiliation with a hospital that can provide them with some sort of leverage in terms of being able to attach to the HOPD or at least HOPD-type rates."
Jeff Peo, vice president of acquisitions and development for ASCOA, agrees that the 100-percent physician-owned model may be a thing of the past for many regions. "The mounting burdens coming from compliance and regulatory issues, as well as the pressure to operate even more efficiently, due to reimbursement trends, will drive the physician-owners to bring in partners they didn't want or need previously," he says.
From: Future of ASCs in Five Years: 10 Predictions on the Most Common Ownership Model
2. ASCs will adapt to ACOs. While the design and implementation of ACOs is still murky, many experts agree that surgery centers that want to stay financially viable well into the future should get involved with ACO development now. Jon Vick, president of ASCs Inc., says ASCs will adapt to the advent of ACOs as they have to changes in the past. "[Centers] have always found a way to be flexible about whatever comes up in the marketplace," he says. "They are used to accommodating to changes in the healthcare system."
Joe Wieck, MD, an orthopedic surgeon with Premier Orthopaedic Surgery Center in Nashville, Tenn., says hospitals and other large groups organizing ACOs for a Jan. 1, 2012, launch date may start courting ASCs and surgeons to share in bundled payments.
From: 8 Changes for ASCs in the Next 10 Years With Jon Vick of ASCs Inc.
3. ASCs may see more volume. According to Dr. Wieck, ASCs may see more volume in the future as the affordability of ASCs becomes evident. He said his group is working with several major carriers to build incentives for policyholders to cases seen in a preferred setting. Ken Pettine, MD, a spine surgeon who co-owns Loveland (Colo.) Surgery Center, predicts Medicare will allow more procedures — especially spine surgery — to be performed in the ASC. While hospitals have opposed this change historically, they may support the transition as more ASCs become hospital-owned.
From: ASC Physicians Identify 14 Stories Which Will Shape the Second Half of 2010
4. Out-of-network facilities will face unique challenges. In some states, OON facilities are facing new laws that reduce OON reimbursements or place caps on OON reimbursement rates. In New Jersey, OON ASCs have historically benefited from very lucrative reimbursement rates, receiving on average three times the reimbursement for being OON than in-network. But that trend may be about to change: New Jersey insurance carriers have recently announced plans to tie OON network reimbursement of ASCs to Medicare. Larry Trenk, president of the N.J. Association of ASCs, says if insurance companies are successful in curtailing or controlling the OON insurance level, the power will shift dramatically from ASCs to payors.
If insurance companies gain extreme leverage over OON ASCs, he predicts in-network ASCs will also be adversely impacted. "If the most they're going to pay you is a certain percentage of Medicare if you're OON, who's to say they're not going to pay the same thing for in-network?" he says. According to Krystal Mims, president of Texas Health Partners, insurance companies in her state are pursuing similar plans.
From: 10 Current Issues Affecting ASCs Nationwide
5. ASC EMR will be essential for sophisticated and integrated data management. According to Sarah Martin, regional vice president of operations for Meridian Surgical Partners, ASCs will have to invest heavily in EMR and data management systems as the government increasingly requires ASCs to submit quality outcomes for reimbursement. "It's definitely a burden for surgery centers, and as a company, none of the current EMR systems we have looked at will work across the board," Ms. Martin says. "We have different software packages at each of our centers because when we acquire a center, we don't make them change over to a different system. That's a problem."
She says going forward, vendors will likely be asked to produce a package that integrates many different software packages across ASCs — a goal that may be difficult to accomplish. There may be hope, however, in money set aside for ASCs by the government to invest in information technology, which would provide centers a great opportunity to join hospitals in sophisticated quality reporting.
From: How Quality Reporting and Information Technology Requirements Will Impact ASCs
1. ASC joint ventures will increase. As ASCs continually struggle to survive against decreasing reimbursements, David Shapiro, MD, partner in Ambulatory Surgery Company, predicts the number of hospital/ASC joint ventures and other joint-venture models will increase. "If we don't bend the cost curve on the way ASCs get reimbursed, many are going to cease to be able to provide services," he said. "So they're going to have to migrate over to affiliation with a hospital that can provide them with some sort of leverage in terms of being able to attach to the HOPD or at least HOPD-type rates."
Jeff Peo, vice president of acquisitions and development for ASCOA, agrees that the 100-percent physician-owned model may be a thing of the past for many regions. "The mounting burdens coming from compliance and regulatory issues, as well as the pressure to operate even more efficiently, due to reimbursement trends, will drive the physician-owners to bring in partners they didn't want or need previously," he says.
From: Future of ASCs in Five Years: 10 Predictions on the Most Common Ownership Model
2. ASCs will adapt to ACOs. While the design and implementation of ACOs is still murky, many experts agree that surgery centers that want to stay financially viable well into the future should get involved with ACO development now. Jon Vick, president of ASCs Inc., says ASCs will adapt to the advent of ACOs as they have to changes in the past. "[Centers] have always found a way to be flexible about whatever comes up in the marketplace," he says. "They are used to accommodating to changes in the healthcare system."
Joe Wieck, MD, an orthopedic surgeon with Premier Orthopaedic Surgery Center in Nashville, Tenn., says hospitals and other large groups organizing ACOs for a Jan. 1, 2012, launch date may start courting ASCs and surgeons to share in bundled payments.
From: 8 Changes for ASCs in the Next 10 Years With Jon Vick of ASCs Inc.
3. ASCs may see more volume. According to Dr. Wieck, ASCs may see more volume in the future as the affordability of ASCs becomes evident. He said his group is working with several major carriers to build incentives for policyholders to cases seen in a preferred setting. Ken Pettine, MD, a spine surgeon who co-owns Loveland (Colo.) Surgery Center, predicts Medicare will allow more procedures — especially spine surgery — to be performed in the ASC. While hospitals have opposed this change historically, they may support the transition as more ASCs become hospital-owned.
From: ASC Physicians Identify 14 Stories Which Will Shape the Second Half of 2010
4. Out-of-network facilities will face unique challenges. In some states, OON facilities are facing new laws that reduce OON reimbursements or place caps on OON reimbursement rates. In New Jersey, OON ASCs have historically benefited from very lucrative reimbursement rates, receiving on average three times the reimbursement for being OON than in-network. But that trend may be about to change: New Jersey insurance carriers have recently announced plans to tie OON network reimbursement of ASCs to Medicare. Larry Trenk, president of the N.J. Association of ASCs, says if insurance companies are successful in curtailing or controlling the OON insurance level, the power will shift dramatically from ASCs to payors.
If insurance companies gain extreme leverage over OON ASCs, he predicts in-network ASCs will also be adversely impacted. "If the most they're going to pay you is a certain percentage of Medicare if you're OON, who's to say they're not going to pay the same thing for in-network?" he says. According to Krystal Mims, president of Texas Health Partners, insurance companies in her state are pursuing similar plans.
From: 10 Current Issues Affecting ASCs Nationwide
5. ASC EMR will be essential for sophisticated and integrated data management. According to Sarah Martin, regional vice president of operations for Meridian Surgical Partners, ASCs will have to invest heavily in EMR and data management systems as the government increasingly requires ASCs to submit quality outcomes for reimbursement. "It's definitely a burden for surgery centers, and as a company, none of the current EMR systems we have looked at will work across the board," Ms. Martin says. "We have different software packages at each of our centers because when we acquire a center, we don't make them change over to a different system. That's a problem."
She says going forward, vendors will likely be asked to produce a package that integrates many different software packages across ASCs — a goal that may be difficult to accomplish. There may be hope, however, in money set aside for ASCs by the government to invest in information technology, which would provide centers a great opportunity to join hospitals in sophisticated quality reporting.
From: How Quality Reporting and Information Technology Requirements Will Impact ASCs