To capitalize on new growth opportunities available to ASCs created by the shift to outpatient surgery, ASCs should look to adopt new technologies and policies to stay competitive.
Tom Shields, CEO of Shields Health Care Group, which develops ASCs and provides outpatient imaging services, weighs in on the top ASC growth trends to know.
Note: Responses have been lightly edited for style and clarity.
Question: What is the biggest opportunity for growth you see for ASCs in the next 10 years? As an ASC leader, how do you hope to capitalize on growth opportunities?
Tom Shields: Thanks to advances in technology, surgical techniques and innovations in post-surgical care, more non-traditional surgical procedures are migrating to the ASC setting. In general, ASC prices are significantly lower than hospital outpatient department prices and the drive to shift where these procedures are performed comes from the additional cost savings that can be achieved. In the more immediate sense, total joint replacements will shift to ASC settings, but this is really just scratching the surface.
Over the next 10 years, this trend will continue with more advanced spine procedures and interventional therapies (vascular and cardiac) creating a bigger opportunity to significantly reduce health care costs. As the number of procedures done at an ASC grows, the demand for ASCs will as well.
As an ASC leader, we’ve designed our business model to keep pace with the demand of market needs today and in the future. As patient financial responsibilities rise and the case mix continues to shift, patients, payers, employers and providers will be looking for a network of ASC facilities they can trust to deliver high-quality care, focus on patient outcomes, provide state-of-the-art technology and low, transparent pricing. We align with physicians who are leaders in their fields and can identify the procedural opportunities and what is needed to implement them.
Our state-of-the-art facilities are constructed to position us for growth so we can move quickly to accommodate new procedures. Our facilities are strategically constructed in regions that are accessible and convenient for patients. We also look to work with employers interested in partnering directly with a network of ASC facilities to help manage the costs of outpatient procedures.
Q: What is your ASC's strategy for patient collections?
TS: As patient financial responsibilities continue to rise (and show no signs of slowing), ASCs need to collect what is owed for the surgery while maintaining their high level of patient satisfaction. The process to effectively capture patient collections as early as possible starts with transparency on price. We have complete transparency in our pricing and provide every patient an upfront estimate on their individual out-of-pocket costs. Preparing them in advance for what their financial responsibility will be at the time of the surgery eliminates surprises and builds greater trust in the service we deliver. It also allows our patients and families to engage in honest conversations about appropriate healthcare spending and planning. We are taking this one step further by building online tools that will enable patients to access this information electronically.
Beyond preparing the patient in advance, we also offer the ability to pay their bill in a secure, simple online system. While the ASC pricing is on average about 40 percent lower than hospital, the out-of-pocket expense can still be significant and we offer payment plans and flexible financial solutions such as CareCredit that help patients cover their surgical costs and pay for it in a manner that fits their budget.
Q: How do you budget for and select new technologies for your ASC?
TS: Our ASC model is a collaboration with physicians that have an ownership stake and perform surgical cases at the facility. The physician owners are actively involved in a clinical advisory committee. Balanced in part by our ASC administrator's budgetary mindset, we leverage their clinical expertise to identify the equipment and technology that best meets the needs of the patient community. We also lean on our medical device partners to communicate what is coming down the pipeline and collaborate with them across our network to leverage economies of scale. Collectively, this committee helps us to stay at the forefront of the market by identifying technology to perform innovative procedures and provide the high-quality surgical care, while doing so efficiently and with better outcomes. For example:
From a surgical standpoint, our 4k technology allows us to provide top-notch care today, but also gives us room to add sophisticated enhancements as time evolves. Additionally, we utilize a secure, cloud-based image retrieval and physician-centric EMR.
From a patient experience perspective, we have begun utilizing post-op personalized videos. With assistance from Arthrex’s Surgeon Vault, Brian Busconi, MD, of The Surgery Center at Shrewsbury (Mass.) now records a video of himself that is sent to the patient immediately following the surgery. This video includes a personalized account of what took place during surgery, how the patient should expect to feel, his instructions or recommendations to expedite healing, and his advisement on any unique issues or concerns the patient has had leading up to the procedure. Dr. Busconi also explains when the patient should follow up in the clinic.
These videos are then emailed to the patients in a HIPAA-compliant manner so when recovering at home and the sedation has worn off completely, they are able to watch the video as many times as they want in order to have a strong understanding of how to best take care of their health. They are also able to share with loved ones who may be assisting in caretaking during the recovery process.
Since Dr. Busconi began utilizing these videos, follow-up calls to the office have decreased by roughly 60 percent.
Q: What is unique about your ASC business model and what do you attribute to its success?
TS: Locally in Massachusetts the high-priced hospital market presents an extraordinary opportunity for innovative providers to drive lower cost, better access and better quality of care in a freestanding setting. We see a significant growth opportunity in business models that facilitate physician alignment with these objectives through their direct ownership —- along with Shields operational and management expertise. In many cases, we have also been able to successfully engage local health systems in our joint venture partnerships.
These forward-thinking health systems are well aware that a growing percent of their patients are in value-based or managed care contracts that incentivize a shift to lower cost site of care on freestanding rates. This business model places equal skin in the game for the physicians, health system and the management company — which we believe is our recipe for success. At the end of the day, this allows us to consistently deliver high-quality surgical care in cutting edge facility at a much more affordable rate.