Krystal Mims, president of Texas Health Partners and a member of the Texas Ambulatory Surgery Center Society, discusses four challenges facing Texas ASCs for the next year.
1. Several insurance companies are planning to tie out-of-network rates to Medicare. According to Ms. Mims, some Texas ASCs have historically pursued the out-of-network model because of limited access to managed care contracts. Ms. Mims recently attended an ASC conference and heard discussion about Blue Cross Blue Shield announcing that out-of-network rates will be tied to Medicare rates, as well as Aetna tying OON rates to Medicare beginning Oct. 1. "If those changes occur, that could affect all the facilities that have historically been out-of-network," she says.
2. Non-compete clauses prevent physician-owners from investing in another facility within the non-compete area. According to Ms. Mims, many physician owners are prevented through non-compete clauses from investing in two facilities within the non-compete area. She says the non-compete presents a challenge in densely populated areas where the community could benefit from two nearby ASCs and could hurt physicians who would like to invest in two neighboring, freestanding ASCs.
3. Small facilities will struggle to staff compliance experts. As compliance with quality regulations becomes part of future reimbursement, smaller facilities may struggle to understand Medicare Conditions for Coverage and other regulatory issues, Ms. Mims says. Expecting an administrator or other staff member to regularly research regulatory issues in addition to their day-to-day responsibilities may prove difficult, and small facilities will be pushed toward building a relationship with a hospital. "Because our facilities are part of Texas Health Resources, we have access to expertise in every area of compliance," she says. "We're looking to help smaller ASCs by providing consulting services. [We can help] if they need us to review that information for them or assist with the development and implementation of a compliance plan."
She says transparency is very quickly becoming essential to Texas healthcare facilities. "It's not going to slow down," she says. "Transparency as it relates to quality, service, satisfaction and cost is everywhere. You can already view this type of information on various internet web sites and this will continue. Patients can see who provides the best value equation for the services they are considering."
4. The move toward ACOs and integrated care models will make it harder for non-integrated ASCs to survive. Ms. Mims says the Texas ASC industry may start to notice an increasing move toward partnerships with hospitals because of the emphasis on integrated care models and accountable care organizations. "Most people believe that standalone entities, including ASCs, hospitals and even physician practices, are not going to be able to survive healthcare reform without integration of healthcare models," she says.
She says EMR implementation will also be an essential part of ensuring a "continuum of care" for each patient, and physicians and ASCs that are aligned with hospitals are in a better position to implement EMR.
"[In the future], whether you're in a surgery center, hospital or physician practice, all the information related to the patient is going to be integrated to improve care and reduce cost," she says. "Free-standing surgery centers are going to [struggle to] accomplish that." She says stand-alone surgery centers may not have the financial resources or staff to effectively implement an EMR.
Learn more about Texas Health Partners.
1. Several insurance companies are planning to tie out-of-network rates to Medicare. According to Ms. Mims, some Texas ASCs have historically pursued the out-of-network model because of limited access to managed care contracts. Ms. Mims recently attended an ASC conference and heard discussion about Blue Cross Blue Shield announcing that out-of-network rates will be tied to Medicare rates, as well as Aetna tying OON rates to Medicare beginning Oct. 1. "If those changes occur, that could affect all the facilities that have historically been out-of-network," she says.
2. Non-compete clauses prevent physician-owners from investing in another facility within the non-compete area. According to Ms. Mims, many physician owners are prevented through non-compete clauses from investing in two facilities within the non-compete area. She says the non-compete presents a challenge in densely populated areas where the community could benefit from two nearby ASCs and could hurt physicians who would like to invest in two neighboring, freestanding ASCs.
3. Small facilities will struggle to staff compliance experts. As compliance with quality regulations becomes part of future reimbursement, smaller facilities may struggle to understand Medicare Conditions for Coverage and other regulatory issues, Ms. Mims says. Expecting an administrator or other staff member to regularly research regulatory issues in addition to their day-to-day responsibilities may prove difficult, and small facilities will be pushed toward building a relationship with a hospital. "Because our facilities are part of Texas Health Resources, we have access to expertise in every area of compliance," she says. "We're looking to help smaller ASCs by providing consulting services. [We can help] if they need us to review that information for them or assist with the development and implementation of a compliance plan."
She says transparency is very quickly becoming essential to Texas healthcare facilities. "It's not going to slow down," she says. "Transparency as it relates to quality, service, satisfaction and cost is everywhere. You can already view this type of information on various internet web sites and this will continue. Patients can see who provides the best value equation for the services they are considering."
4. The move toward ACOs and integrated care models will make it harder for non-integrated ASCs to survive. Ms. Mims says the Texas ASC industry may start to notice an increasing move toward partnerships with hospitals because of the emphasis on integrated care models and accountable care organizations. "Most people believe that standalone entities, including ASCs, hospitals and even physician practices, are not going to be able to survive healthcare reform without integration of healthcare models," she says.
She says EMR implementation will also be an essential part of ensuring a "continuum of care" for each patient, and physicians and ASCs that are aligned with hospitals are in a better position to implement EMR.
"[In the future], whether you're in a surgery center, hospital or physician practice, all the information related to the patient is going to be integrated to improve care and reduce cost," she says. "Free-standing surgery centers are going to [struggle to] accomplish that." She says stand-alone surgery centers may not have the financial resources or staff to effectively implement an EMR.
Learn more about Texas Health Partners.