MEDICARE MONITOR
Leveraging ASCs in a Redefined World As the nation’s health delivery system continues to evolve, ASCs and policymakers need to take steps to protect the many benefits ASCs provide. BY JONATHAN BEAL
D
ramatic changes that have taken place in the US health care system
in recent years will continue to redefine the ways patients obtain the care they need for years to come. The steps out- lined below can help preserve and en- hance patient access to the high quality, cost-effective care that ASCs offer.
Pay ASCs fairly On average, the Centers for Medicare & Medicaid Services (CMS) currently pays ASCs less than 60 percent of what it pays hospital outpatient departments (HOPD) for performing the same procedures. An even greater concern is that the payments between the two settings will continue to diverge over time unless CMS changes the way it updates ASC payment rates each year. To date, arguments that CMS should use the same annual update factor for HOPDs and ASCs have fallen on deaf ears. ASCs must continue to make the argument that the growing disparity between what CMS pays the two set- tings threatens to undermine the vi- ability of ASCs. CMS needs to real- ize that payment policies that unduly favor higher cost settings are not in the Medicare program’s long-term interest and adopt policy changes that support more cost-effective providers.
Capitalize on technological advances without delay Thanks to recent medical advances, procedures that once required hospi- talization are now performed routinely in the outpatient setting. For example, cataract removals were once performed primarily in the inpatient setting. Now, that idea is unfathomable. This trend continues today. For example, many providers are performing, and private
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payers are paying for, total knee pro- cedures that are done without hospital- ization in ASCs and HOPDs. Moving forward, it is critical that CMS takes advantage of what technological ad- vances make possible and takes steps to fully capitalize on the benefits that the outpatient setting provides.
Educate all involved on the benefits of ASCs ASCs have long offered high quality, convenient and cost-effective care, but patients, purchasers and doctors contin- ue to remain largely unaware of this. In the more consolidated health care mar- ketplace expected in the future, ASCs will need to do more to combat this lack of understanding in order to compete effectively. ASCs will need to educate patients to be more active consumers by informing them about the cost dif- ferences that exist between ASCs and HOPDs. ASCs will also need to make health plans and employers more aware of the savings potential that ASCs offer so that they can take steps to encourage the use of ASCs by their subscribers and employees. Finally, as the trend toward consolidation in the health care commu- nity continues, ASCs will find increasing challenges in relying solely on physician owners to bring patients into the ASC. Instead, ASCs will need to market the benefits they offer to all of the physician groups in their community.
Recognize the advantages that physician involvement in ASCs offers Some members of the health care com- munity continue to view physician financial involvement in ASCs with suspicion. Despite a dearth of support- ing evidence, they contend that allow- ing a physician to invest in a facility
and share in the profits that the facility generates, leads to over-utilization of care as surgeons schedule unnecessary surgeries based on a pecuniary self in- terest. This myth must be dispelled and the importance of health care provider involvement in building the health de- livery system of the future recognized. ASCs provide a compelling example of how direct physician involvement can lead to better and less costly care. For the advantages of ASCs to be leveraged to the fullest extent possible, it will be critical for ASCs to continue to push this narrative to help policy makers let go of these unfounded suspicions.
Reduce barriers to ASC entry into markets Although growth in the total number of ASCs across the country has leveled off in recent years, for many years after the first ASC opened, the community grew steadily. The prevalence of ASCs, however, is not equal in all areas. In- stead, ASCs are ubiquitous in some states, such as Florida, and almost non- existent in others, such as Alabama. One of the reasons for this inequitable distribution is the onerous Certificate of Need (CON) requirements that ef- fectively prevent ASCs from being es- tablished in certain states. The effect is two-fold: first, some markets benefit from ASCs and some do not; second, ASCs have access to some markets but not others. Recently, several states have removed their CON requirements, and if more states follow suit, ASCs will see additional market opportunities and patients in those markets will have more choices for obtaining the surgical services that they need. To protect patient access to ASCs, and the cost-savings, quality and con- venience that ASCs offer, the ASC community and policy makers need to act now.
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