For years, healthcare has focused on treating sick patients. Now, providers are turning their attention to population health, which preaches keeping patients healthy and out of the hospital.
"It's truly a paradigm shift," says Regent Surgical Health Director of Operations Vivek Taparia. "It's like telling auto mechanics to stop just treating the problem and instead doing maintenance on our cars so we don't have to come in for repairs. Hospitals are used to doing major repairs, but now in healthcare we want to succeed by making sure everyone is healthy and that health is maintained."
Hospitals are making that shift to provide more services beyond surgical care, but where do ambulatory surgery centers fit?
"ASCs are sitting on a lot of value," says United Surgical Partners International Senior Vice President, Acquisitions Michael
Stroup. "They are on the right side of the value equation. We can provide the site of care for these ambulatory events at a good price because we have all the data and it's easier for us to define our costs."
There are many consulting firms now dedicated to helping hospitals make this transformation, signing multi-year contracts with health systems. Many of the 218 USPI centers have hospital partners, including non-for-profit hospital partners.
"This is an opportunity for non-for-profit health systems to demonstrate their cost-effectiveness," says Mr. Stroup. "Many hospital systems may want to dial down their cost per episode and you can't do that with 95 percent inpatient."
There are three ways Mr. Taparia sees ASCs participating in population health:
1. Quality — ASCs have a lower infection rate than hospitals and can treat patients in the highest quality setting.
2. Focused operations — ASCs do more specific surgeries and have built service lines around a single procedure with less variation and proper protocols, which leads to fewer complications.
3. Access — ASCs are easier to construct and expand to multiple locations around the city to have easier access for community members. They can also co-locate in medical office buildings to create a consumer-centric feel. Additionally, ASCs are smaller and less complex than hospitals, making them more patient-friendly. The ASC's parking lot is easier to navigate and it's not a maze to find the surgery desk; patients are in and out.
"Population health also pays attention to outcomes per dollars spent," says Mr. Taparia. "When you lower the cost equation as part of a value-based system, ASCs have a role to play. Quality, cost and access all play an important role for ASCs to further population health with communities."
But as part of population health initiatives, providers are taking on more risk. Most payers and providers don't currently have an infrastructure that efficiently transitions risk.
"We are helping our provider partners put themselves in a good position to accept risk," says Mr. Stroup. "Leading NFPS with effective risk management skills will seek to broaden their assumed risk to increase the breadth of potential savings and control over care. One can see why the traditional ASC would partner or acquire ancillary services, freestanding emergency departments, home health and urgent care — to secure a larger slice of the pie."
Most ASCs won't be able to acquire all verticals, but they can work with others focused on similar issues to take more out of every dollar. Right now, many providers are pursuing packaged pricing but in the future you could see a transition to managing the episode of care so the facility works to keep patients out of the operating room instead of just focusing on making the OR more efficient.
"There are people doing that now with total joints and GI," says Mr. Stroup. "These are more easily defined specialties so physician groups can provide surgery as well as the ancillaries. Many ASC companies are trying to figure out how they and the hospital partners can bundle services and sell those to employers, self-funded insurers, hospital partners and payers."
Bundled payments also simplify the billing process.
"There is less red tape to go through before patients have access to surgical care," says Mr. Taparia. "This also furthers to goals of population health."
There are some surgery centers making changes to the traditional independent, physician-run model to become more desirable as a partner in population health. Hospitals are trying to create "care communities" focused more on outpatient services than inpatient care, and ASCs are partnering in either joint ventures or other alignment options to fill that void.
ASCs are expanding to multiple locations and becoming part of medical campuses that also include services like lab testing, pharmacies and health clubs in addition to clinic space.
"The idea is to create a model for convenient healthcare that is consumer-centric and focused on retail," says Mr. Taparia. "The care is out in the community instead of making the community come to the care. At this campus you go to the health club, you can also eat the healthy food and it's also close to a Starbucks. You can do ordinary things within the same area of the clinical services."
The first step to making this transition is looking at your service lines and deciding where to really focus efforts.
"You're not going to take half the dollar spent tomorrow, so make it easy for the risk-bearing entities to transfer risk to the ASC," says Mr. Stroup. "Figure out how to pinpoint the costs with an easy-to-implement service and align physicians with ancillary providers on the bundle."
This is easier for single-specialty centers; putting resources in to a bundle for seven GI procedures performed per week at a multispecialty center doesn't make sense, but 70 procedures at a GI center does. Hospital partners may help, but aren't necessary for physician groups to take advantage of population health.
"You don't have to be partnered with a health system to participate," says Mr. Taparia. "There are medical groups out there participating in risk-based contracts and these organizations own ASCs. It's helpful to integrate with a broader health system, but not imperative."