COVER STORY
have started working with the insur- ance companies, we are giving them reasonable rates to reimburse at in the ASC setting. They might be paying a hospital a facility fee that can be nego- tiated at a lower rate in the ASC set- ting. That type of investigation/due diligence especially has to go on when you take on higher end or specialized procedures. In the state of Maryland, CareFirst has structured a separate and higher professional fee for certain ASC procedures to potentially incen- tivize the physicians to perform those procedures in an ASC setting.” Payer expectation is key, Armistead
says. “We are seeing a great interest from the payers and that is a good sign for us. When negotiating with these payers, we have to reinforce with them the experience the patient will have and the outcome they will have. These are important for driving this side of the business for the ASC. This is a real growth area for ASCs.” Total joint is still on the inpatient
only list for Medicare claims, Armistead says. “They can be done in the hospi- tal outpatient setting but are usually done in the inpatient setting. We have just started doing it in 2013. We have been doing total shoulders and unicomp [unicompartmental] knee replace- ments since 2008.” Medicare added the unicomp replacement to its ASC list recently. “We see a real interest from the payers to get total joint procedures done in the ASC setting, simply because the experience is positive for the patient and it is lower cost,” Armistead says. For Rosenfield’s field of work,
“we need ASCA behind us for this because the insurance companies are unfamiliar with the CPT codes,” he says. “Less than 1 percent of hyster- ectomies in the US are performed in the ASC setting.” While the surgery requires a spe- cific skill set, Rosenfield has been teaching and training surgeons on this approach for several years and believes
We see a real interest from the payers to get total joint procedures done in the ASC setting, simply because the experience is positive for the patient and it is lower cost.”
—Cynthia Armistead, Campbell Surgery Center
it is very scalable and reproducible. “ASCs can perform the procedure at a much reduced rate than hospitals,” he says. “However, the current CMS rates set for these operations are less than cost to perform the surgery, so there is a lot of work that needs to be done to make this transition successful.” Pearl SurgiCenter has been per-
forming hysterectomies since 2005, Rosenfield says. “There are only a few centers in the US, including ours, that offer ASC outpatient hysterectomy. Overall, the number is extremely low right now. So, our aim is to raise aware- ness of this opportunity of transition-
ing to the ASC setting. The same hap- pened with spine cases transitioning in the ASC setting, allowing for improved outcomes at reduced cost. Gynecology surgery represents the ‘next big thing’ in the ASC market.
“Because of the demographics, Medicare patients don’t typically need this
surgery, so CMS needs better
information on cost to come up with a reasonable fee schedule,” Rosenfield continues. “We need to work with CMS on getting this procedure fairly covered. Performing hysterectomy in the ASC setting is in the best interest of the patient and our health care system.”
ASC FOCUS JANUARY 2015 17
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