Robert Zasa, MSHHA, FACMPE, founding and managing partner of ASD Management, reveals three key trends that will help shape the ambulatory surgery center industry in 2014. Reform is driving a myriad of changes in the healthcare industry and predicting what the year ahead holds is no easy task. There a number of big movements in the industry — consolidation, downward pressure on reimbursement, price transparency, a shift to value-based care to name just a few. So many that it becomes difficult to know where to look for expertise.
Robert Zasa, MSHHA, FACMPE, founding and managing partner of ASD Management, narrows the focus and sheds light on three big trends that all ASC leaders should know and follow to remain successful in the healthcare environment of 2014.
1. Private health insurance exchanges. Private health insurance exchanges are popping up in the wake of the exchanges mandated by Patient Protection and Affordable Care Act. The exchanges represent a major transformation of healthcare delivery from a system driven by providers and payers to a system fueled by consumerism. Private exchanges are an opportunity for surgery center leaders to find a place in the changing market. "Private exchanges are very attractive for businesses with less than 50 employees," says Mr. Zasa. "We are trying to figure out how to participate."
In California, Mr. Zasa is observing healthy activity in private exchanges. He is investigating the exchanges and the possible level of reimbursement. It is early in the game to know how relationships with exchanges will pan out, but whether through direct contact or employers, ASCs can participate in a narrow network and succeed as a provider. "Gather a list of private exchanges. Call them routinely and see if you can network with them," he says.
2. Revenue cycle management. With the upheaval of the healthcare market comes a great deal of confusion. ASC leaders are spending more and more time chasing reimbursement, trying to close the gap between what their center is paid and what it should actually receive. Successful surgery centers will acknowledge and tackle the need for improved revenue cycle management.
"With lower reimbursement, it is now even more imperative," says Mr. Zasa. More internal controls for careful revenue cycle management is necessary to combat lost revenue and eliminate time needed to file appeals and fight for proper reimbursement.
3. New physicians entering the market. The pressure in the current healthcare environment has lead to the looming concern of a physician shortage. Older physicians may opt for early retirement rather than battle to find a successful niche in a high pressure market. Students may lean towards career paths other than medicine. Hospitals, health systems and ASCs will be in fierce competition for the physicians that remain active. "Providers are scrambling to retain business, but there is also the opportunity to gain new business," says Mr. Zasa.
New physicians will still enter the market; younger physicians will seek ways to augment case volume and revenue and physicians dissatisfied with the large provider model will look outside the hospital walls. ASC leaders have a low-cost, high-quality platform and they are poised to attract physicians with this model. At ASD Management centers, leaders are reaching out to payers for names of potential physicians. ASC physician partners are attuned to the local market and know when a new physician enters the area and the potential this represents.
Both physicians and patients are scrambling to find a place in the new healthcare market. "Payer panels are changing," says Mr. Zasa. Payers are dropping physician groups and health plans. Though ASCs have an advantage to attract patients and physicians as a low-cost environment, leaders need to consider how patient selection is being interrupted. There is new business to be gained, but the question becomes how to obtain that business appropriately. ASC leaders need to analyze the market around their center and be prepared to create a plan to draw the physicians and patients that will help bolster their centers' success.
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