Peggy Wellman, past president of the California Ambulatory Surgery Association, has worked in the California ASC industry for 30 years. She's market president for the Pacific market of United Surgical Partners International and oversees the operation of 33 ASCs in California and Oregon, where she works with several health system partners and medical foundations. Ms. Wellman spoke with Becker's ASC Review about technological advancements on the way for ASCs, the latest ASC news from CMS and more.
Note: Responses have been lightly edited for style and clarity.
Question: What challenges are ASCs facing in California right now? How are they different or similar to those in Oregon?
Peggy Wellman: I see more of an opportunity in California. Our state has really been on the forefront of population health, and capitation in a payment form has been around 20 years at least. We have some very robust cost engagement strategies in place for the larger medical groups and health systems. There's been a focus on what portion of our dollars healthcare consumes, and more of a focus on appropriate site of service and reduction of cost to patients, employers and the government market as well.
Here in California we have large and organized medical groups that are able to take a capitated payment from insurers. There's a prohibition against the corporate practice of medicine in California, which means that our health system partners can't employ physicians. In Oregon, the health systems can employ physicians, so there's a little bit of a different flavor in Oregon.
Q: What are your reactions to the recent news from CMS? Is there anything you think CMS should've proposed that they didn't?
PW: It's exciting that CMS is recognizing that [ASCs] can perform more complex cases. The proposal for total knee replacements in our setting on Medicare patients is a recognition of the many years that some facilities across the country have broken new ground in that space. Last year, [CMS] added it to the hospital outpatient department approved list, and then this year, they're proposing to put in on the surgery center list, so it's a pretty quick transition. Next year [CMS] is proposing to add total hips to the hospital outpatient department approved list, so that's a good transition as they look to approve things on the ASC list, they typically have had to move them onto the HOPD list first.
In California, with the exception of joints and more complex spine, I don't see us limited by CMS. They've gotten much more progressive.
Q: Can you speak a little about ASCs' role in population health management?
PW: Medical groups have spoken a long time about the Triple Aim — providing affordable care with exceptional outcomes with exceptional patient service. The focus has been for us to demonstrate how we provide affordable care, exceptional outcomes and exceptional experience. As we've all migrated to using more third-party companies to do patient experience surveys and be involved in the reporting we do to the ASC Quality Collaboration, the focus has been to move more procedures into our ASCs.
I was doing a little research the other day, and what I found interesting was the coining of the "Quadruple Aim" — adding exceptional experience for providers. With more of us aging and consuming more of the healthcare dollar, there's a need for more physicians and more nurses in our system. There's been an increased focus on making sure our providers are happy, too.
I think [ASCs] provide an excellent value proposition for physicians in terms of being able to work in an efficient environment and at a very personal level with patients. Hospitals are needed, and we've been able to help them, with our health system partners, identify cases that should be done in [the ASC] setting so they're able to provide more support to more complex cases that require inpatient resources. We're helping to be more efficient with the healthcare dollar as well in terms of whether [hospitals] need to spend money building new ORs, or just patterning with an ASC.
Q: What technological advancements do you think are on the horizon for ASCs?
PW: I think the biggest change for us is being able to do joint replacement and more spine procedures.There's been more rigor and clinical practice guidelines for pain management around those procedures. Some of the nonopioid medicines available to use that have a long-acting ability to manage pain have enabled us to get patients out the door and into their own homes sooner with appropriate caregivers. Thinking about other technology that may be driving that. In the cardiology arena, while I believe these procedures that we're now doing have been done on an outpatient basis in the hospital, it was recognized it's just much more efficient to do it in an [ASC} setting. The patient spends less lime in the facility, and the technology continues to get smaller, like implantable devices.
Q: Where do you think the ASC industry will be in the next three to five years?
PW: I was reflecting on how we've pivoted from working directly with physicians, making sure that they have a say in who we employ, what policies are in place clinically for the care of their patients and the equipment we support. Then we moved to speaking directly with the payers, helping them to understand what we were capable of, and then we progressed with partnering with hospitals and health systems. Now we're having to focus on the patient as a consumer. We're more focused on patient experience with third-party measurements that can stand on their own, measuring how good our experience is for patients. [ASCs] offer transparency on cost — if you need to have a surgery done in a surgery center, it's easy for us to tell you what your benefit is, what your share of the cost will be — there shouldn't be any surprises when you go to a surgery center. It's a much simpler place to understand what your expenses will be.
We're moving into new types of technologies that allow us to communicate better with patients on the front end. Some IT platforms offer up to 85 different languages. In California, we have many different people speaking languages other than English, so the ability to get health information from them through this technology has been wonderful. Being able to communicate with our vendors, we can assure that items needed for patients' care will be available with us. It's pretty exciting.
What's also important in looking toward what's next for surgery centers has been the ability to do more things with the capacity that we have. There is a wide range of [procedures] hospitals are able to provide on an outpatient basis that we may be able to provide efficiently as well. It's way past anything that's considered appropriate for us to do, but I do think there will be some push for that in the future as well.
Q: Over the course of your career, how have you seen the industry change?
PW: When I first started in surgery centers, we were needing to prove to physicians, patients and insurers that we were a safe place to take care of patients, [which] was a novel idea to a number of those audiences. Now, we're in a place where those audiences are coming to us and looking to us to do more complex cases. For example, we're moving ahead with more total joints done on an outpatient basis, more spine on an outpatient basis; cardiology is now moving to an outpatient basis, as well as more extensive vascular procedures. Some of that is being driven by the payers instead of us going to the payers and helping prove the safety.
Note: Comments on CMS' proposed changes to the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs can be submitted here. Comments will be accepted no later than 5 p.m. EST Sept. 27.
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