Surgical case migration from hospitals to ASCs is an unstoppable trend, prompting hospitals, health systems and independent practices to develop dedicated ASC strategies.
During a roundtable discussion at Becker's 30th Annual Meeting: The Business & Operations of ASCs, two leaders from ECG Management Consultants — Naya Kehayes, retired partner, and Dakon Montgomery, principal — provided insight into key themes for creating a successful ASC strategy.
Below are the four key takeaways from their discussion.
- A successful ASC strategy has three elements.
- Strong payer relationships and arrangements that enable appropriate rates, allowing for increased freedom in surgical site selection
- Provider alignment via aligned incentives (quality, satisfaction and equity)
- Optimized operations via an adequate management structure and optimized capacity across the delivery continuum (hospital, hospital outpatient department and ASC)
- Developing an effective payer strategy requires demonstrating value and savings to payers.
It is essential that leaders:
- Understand potential ASC volume in their market, market rates, cost structure and capital requirements.
- Use this data to develop rate targets, quantify the value opportunity of surgery migration and identify their most valuable resources (e.g., high-value physicians).
- Offer discounts on HOPD rates or align ASC payer negotiations with hospital contract negotiations.
- Different ASC structures drive different levels of provider alignment.
There are three main modalities for ASC structures, each of which offers distinct incentives to providers:
- Independent partnerships — offer flexibility and nimbleness
- An ASC platform company — offers growth and scalability
- Wholly-owned ASC — offers increased capacity in the main operating room while shifting lower-acuity cases to ASCs, bringing down the total cost of expansion
Ms. Kehayes and Mr. Montgomery noted that each modality also permits progressively stronger negotiating power with payers.
- ASC management options fall into three main categories.
Those categories include:
- Independent management
- A management company
- A management services organization
Similar to the modalities for ASC structures and their impact on payer negotiating power, each of the ASC management categories offers progressively higher levels of support for business development, strategy, clinical operations, compliance, finance and business operations.
Ms. Kehayes and Mr. Montgomery emphasized that irrespective of which management structure an organization selects, ASC expertise is essential to long-term success.