Here are six ways GI/endoscopy-driven ASCs will change in the next five years.
1. Practice of anesthesiology. GI- or endoscopy-driven ASCs could see lowered case volumes at their facility if the government decides to decrease reimbursement on anesthesia services. Brian Jacobson, MD, FASGE, who is a GI physician at Boston (Mass.) Medical Center, associate professor of medicine at Boston (Mass.) University's School of Medicine and chair of the American Society for Gastrointestinal Endoscopy’s Health and Public Policy Committee, says a decrease in payment for those services is very possible, which directly affects patients' accessibility to procedures requiring anesthesia.
"A decrease in payment for anesthesia services related to screening colonoscopies could have a significant impact on patient throughput because you generally care for more patients in this way by sedating them more efficiently and recovering them more quickly versus sedation," Dr. Jacobson says.
Michael Weinstein, MD, a GI physician at Capital Digestive Care in Chevy Chase, Md., adds the relationship GI ASCs have now with anesthesiologists can change significantly in the years to come. "How will sedation or anesthesia be carried out in GI ASCs? Will it be propofol being administered by GI specialists with new devices and trained nurses, or will it be propofol being more expensively administered with CRNAs or anesthesiologists? There are many regulatory issues surrounding anesthesiology that may vary even across different regions," Dr. Weinstein says.
2. GI-specific quality measures. Dr. Jacobson says that while there are plenty of quality measures ASCs and hospitals can report to payors and the federal government for increased payments, many of the quality measures that may be good for ASCs are not necessarily geared for a GI/endoscopy-based ASC.
"The new healthcare reform law is asking for quality measure reporting for ASCs, and that's something ASGE is very involved in right now," Dr. Jacobson says. "We're trying to develop GI ASC-appropriate measures, such as quality measures that would relate more to proper reprocessing of endoscopes for disinfecting."
Dr. Weinstein adds that as reporting requirements for ASCs continue to take shape, GI/endoscopy-driven ASCs must be mindful of reporting measures over the full continuum of care.
"It's hard for physicians to do reporting of patient care quality measures and only look at the ASC without looking at the medical practice of the physicians using the ASC because those two are very much intertwined," Dr. Weinstein says. "The ASCs may be able to report on very specific GI procedural things, but when we're talking about patient outcomes that aren't determined until after those procedures, they can't exclude medical practices. So I think we'll start seeing quality measurement and other registries that cross over from medical practice to the ASC and back again, like those being developed by the AGA."
3. Increased number of practice mergers may drive ASC development. Dr. Weinstein says the precarious state of the economy, healthcare reform, information technology costs and administrative requirements have been causing physicians to consider corporate partnerships with larger management companies or hospitals in order to survive and remain financially viable. Going forward, as physicians merge there will be some ASC development as the more cost-efficient location for services. Depending on the size of a community or the size of the merged medical practice, the additional development might be either single- or multi-specialty ASCs.
"When I look into the future, I believe we'll start seeing larger physician groups formed, and based on whether it's a rural area or a more populated area, it could be a merger to create either single-specialty large groups or a large multi-specialty practice," Dr. Weinstein says. "In more rural areas, you'll likely see more multi-specialty groups forming, whereas more single-specialty mergers will occur in more densely populated areas. The type of ambulatory surgery center development should mirror the practice development. It's a function of size because in a rural setting, there wouldn't be enough GI specialists to make it cost-effective to have a single-specialty ASC."
4. Changing ASC ownership. As the baby boomer generation continues to age and more and more employees, including GI physicians at ASCs, consider retirement and leaving the healthcare industry, it is incumbent upon GI ASCs to consider how to address the generational differences between older physicians and a younger workforce. Dr. Weinstein says ASCs have to ask themselves how the facility, assuming it is already well-run and well-staffed, will migrate to a different and new medical staff over the next several years.
"Original partners may be trying to figure how to get out while the new physicians are trying to get in," Dr. Weinstein says. "That transition probably helps corporate venture reorganization because it's a way for the original physician-owners to divest some of their assets at large multiples, but ASC profitability only works if the younger physicians stick around. So that's one of the biggest hurdles we're going to see is how those facilities are going to transition to newer, younger partners and how they will create fair arrangements with those partners so that they stay at the ASC."
5. ACO involvement. With the advent of accountable care organizations and bundled payments resulting from healthcare reform, GI/endoscopy-driven ASCs will likely be involved in ACOs and face different payment models as it relates to GI care in the coming years. Dr. Weinstein says that for GI services, this means possibly bringing together GI specialists, ASCs, pathologists and anesthesiologists to share a single pot of money to divide among all the providers for a single episode of care.
"I think it's really going to be the GI specialists that quarterback the episode of care for GI conditions like reflux disease, IBD and colorectal cancer screening," Dr. Weinstein says. "So those specialists will be responsible with working with endoscopic facilities for a procedure, and I think the ASC location will be the logical choice because it truly is the lowest cost, highest value setting for endoscopy procedures."
He also says the drastic changes in the payment system will likely benefit GI specialists who use ASCs because those two entities are able to work together to control where GI patients should go for the best value and best outcomes, which is at GI/endoscopy-driven ASCs.
6. Drops in patient volume, but not for long. Dr. Weinstein says that every ASC's patient volume was likely hit as a result of the economy, as millions of individuals continue their struggle to find employment. Higher deductibles and copays likely keep patients from seeking elective procedures at GI ASCs as well. Consequently, ASCs have been looking for ways to cut overhead costs in staffing and supplies to make up for the hit to patient volume, either by cutting back employee shifts, decreasing employee benefits or laying off employees altogether. Despite this bleak picture, Dr. Weinstein says this trend likely won't keep up for long.
"I think patient volumes will likely come back because preventive care is at the core of healthcare reform and eventually patients are going to ask themselves if they need a colorectal screening as they get older. With wider insurance coverage of screening, I think GI patient volume will stabilize again," he says. "So as long as more people have routine screening and seek out having it done in an efficient setting, ASC volumes will be fine. As long as people have colons, colorectal cancer screening will be around."
On the other hand, Dr. Weinstein says ASC patient volume may be in danger of decreasing in the future if advancements in technology start replacing GI procedures altogether. "Right now, the most common screening test is colonoscopy, and who's to say that some disruptive technology will not come around in the next few years and replace colonoscopy as the screening test of choice. It's an analysis even with new technology because there's the question of whether the technology will decrease volume because it replaces colonoscopy procedures or if it will it bring more business because the technology identifies more patients who need some procedure to take the polyps out," he says. "It's still a bit of an unknown."
1. Practice of anesthesiology. GI- or endoscopy-driven ASCs could see lowered case volumes at their facility if the government decides to decrease reimbursement on anesthesia services. Brian Jacobson, MD, FASGE, who is a GI physician at Boston (Mass.) Medical Center, associate professor of medicine at Boston (Mass.) University's School of Medicine and chair of the American Society for Gastrointestinal Endoscopy’s Health and Public Policy Committee, says a decrease in payment for those services is very possible, which directly affects patients' accessibility to procedures requiring anesthesia.
"A decrease in payment for anesthesia services related to screening colonoscopies could have a significant impact on patient throughput because you generally care for more patients in this way by sedating them more efficiently and recovering them more quickly versus sedation," Dr. Jacobson says.
Michael Weinstein, MD, a GI physician at Capital Digestive Care in Chevy Chase, Md., adds the relationship GI ASCs have now with anesthesiologists can change significantly in the years to come. "How will sedation or anesthesia be carried out in GI ASCs? Will it be propofol being administered by GI specialists with new devices and trained nurses, or will it be propofol being more expensively administered with CRNAs or anesthesiologists? There are many regulatory issues surrounding anesthesiology that may vary even across different regions," Dr. Weinstein says.
2. GI-specific quality measures. Dr. Jacobson says that while there are plenty of quality measures ASCs and hospitals can report to payors and the federal government for increased payments, many of the quality measures that may be good for ASCs are not necessarily geared for a GI/endoscopy-based ASC.
"The new healthcare reform law is asking for quality measure reporting for ASCs, and that's something ASGE is very involved in right now," Dr. Jacobson says. "We're trying to develop GI ASC-appropriate measures, such as quality measures that would relate more to proper reprocessing of endoscopes for disinfecting."
Dr. Weinstein adds that as reporting requirements for ASCs continue to take shape, GI/endoscopy-driven ASCs must be mindful of reporting measures over the full continuum of care.
"It's hard for physicians to do reporting of patient care quality measures and only look at the ASC without looking at the medical practice of the physicians using the ASC because those two are very much intertwined," Dr. Weinstein says. "The ASCs may be able to report on very specific GI procedural things, but when we're talking about patient outcomes that aren't determined until after those procedures, they can't exclude medical practices. So I think we'll start seeing quality measurement and other registries that cross over from medical practice to the ASC and back again, like those being developed by the AGA."
3. Increased number of practice mergers may drive ASC development. Dr. Weinstein says the precarious state of the economy, healthcare reform, information technology costs and administrative requirements have been causing physicians to consider corporate partnerships with larger management companies or hospitals in order to survive and remain financially viable. Going forward, as physicians merge there will be some ASC development as the more cost-efficient location for services. Depending on the size of a community or the size of the merged medical practice, the additional development might be either single- or multi-specialty ASCs.
"When I look into the future, I believe we'll start seeing larger physician groups formed, and based on whether it's a rural area or a more populated area, it could be a merger to create either single-specialty large groups or a large multi-specialty practice," Dr. Weinstein says. "In more rural areas, you'll likely see more multi-specialty groups forming, whereas more single-specialty mergers will occur in more densely populated areas. The type of ambulatory surgery center development should mirror the practice development. It's a function of size because in a rural setting, there wouldn't be enough GI specialists to make it cost-effective to have a single-specialty ASC."
4. Changing ASC ownership. As the baby boomer generation continues to age and more and more employees, including GI physicians at ASCs, consider retirement and leaving the healthcare industry, it is incumbent upon GI ASCs to consider how to address the generational differences between older physicians and a younger workforce. Dr. Weinstein says ASCs have to ask themselves how the facility, assuming it is already well-run and well-staffed, will migrate to a different and new medical staff over the next several years.
"Original partners may be trying to figure how to get out while the new physicians are trying to get in," Dr. Weinstein says. "That transition probably helps corporate venture reorganization because it's a way for the original physician-owners to divest some of their assets at large multiples, but ASC profitability only works if the younger physicians stick around. So that's one of the biggest hurdles we're going to see is how those facilities are going to transition to newer, younger partners and how they will create fair arrangements with those partners so that they stay at the ASC."
5. ACO involvement. With the advent of accountable care organizations and bundled payments resulting from healthcare reform, GI/endoscopy-driven ASCs will likely be involved in ACOs and face different payment models as it relates to GI care in the coming years. Dr. Weinstein says that for GI services, this means possibly bringing together GI specialists, ASCs, pathologists and anesthesiologists to share a single pot of money to divide among all the providers for a single episode of care.
"I think it's really going to be the GI specialists that quarterback the episode of care for GI conditions like reflux disease, IBD and colorectal cancer screening," Dr. Weinstein says. "So those specialists will be responsible with working with endoscopic facilities for a procedure, and I think the ASC location will be the logical choice because it truly is the lowest cost, highest value setting for endoscopy procedures."
He also says the drastic changes in the payment system will likely benefit GI specialists who use ASCs because those two entities are able to work together to control where GI patients should go for the best value and best outcomes, which is at GI/endoscopy-driven ASCs.
6. Drops in patient volume, but not for long. Dr. Weinstein says that every ASC's patient volume was likely hit as a result of the economy, as millions of individuals continue their struggle to find employment. Higher deductibles and copays likely keep patients from seeking elective procedures at GI ASCs as well. Consequently, ASCs have been looking for ways to cut overhead costs in staffing and supplies to make up for the hit to patient volume, either by cutting back employee shifts, decreasing employee benefits or laying off employees altogether. Despite this bleak picture, Dr. Weinstein says this trend likely won't keep up for long.
"I think patient volumes will likely come back because preventive care is at the core of healthcare reform and eventually patients are going to ask themselves if they need a colorectal screening as they get older. With wider insurance coverage of screening, I think GI patient volume will stabilize again," he says. "So as long as more people have routine screening and seek out having it done in an efficient setting, ASC volumes will be fine. As long as people have colons, colorectal cancer screening will be around."
On the other hand, Dr. Weinstein says ASC patient volume may be in danger of decreasing in the future if advancements in technology start replacing GI procedures altogether. "Right now, the most common screening test is colonoscopy, and who's to say that some disruptive technology will not come around in the next few years and replace colonoscopy as the screening test of choice. It's an analysis even with new technology because there's the question of whether the technology will decrease volume because it replaces colonoscopy procedures or if it will it bring more business because the technology identifies more patients who need some procedure to take the polyps out," he says. "It's still a bit of an unknown."