environment, so we can reimburse our physicians at a competitive rate and attract more physicians to this model than a bundled payment in hospitals. They are having to reduce physician reimbursement to bring the cost of these bundles down to where the mar- ket wants them to be.” A significant contributor to the orga-

nization’s ability to grow the number of bundled payments is the use of its “Recovery Inn,” a skilled nursing facil- ity attached to the ASC, Kubiak says. “It is capable of taking care of patients as long as is medically necessary fol- lowing a procedure. When we per- form a total hip or knee replacement, for example, patients are operated on in the ASC and transferred over to the Recovery Inn on the same day, where they recover for a few days before going home. While most of our patients go home the same day, our physicians are comfortable performing more com- plex procedures because they can keep patients for an observation.” The organization is also growing

its bundled payments through a part- nership with Fox Valley Hematol- ogy & Oncology, an oncology group with locations throughout Wisconsin. “They wanted to start a freestanding cancer center because they thought they could reduce the cost of can- cer care similar to the way we have reduced the cost of musculoskeletal care,” Kubiak says. “They opened a facility attached to our building, and now we share ancillary services like medical imaging and laboratory. We have started three price bundles with them and are looking to expand that over the next few years.”

Working with Hospitals For ASCs not ready to pursue value- based contracting on their own, there might be an opportunity to participate in value-based programs through a partnership with hospitals, says Matt Kilton, an associate principal with

ticipate in its bundled payment pro- gram,” he says. “In this situation, the ASC would not control the bundle or direct the dollars. Rather, it would par- ticipate in the bundle and become a part of a delivery system. ASCs may want to consider engaging in discus- sions with their local hospitals about possible value-based partnerships.”

The federal government and society at large have embraced the concept of value-based care. ASCs and their physicians would be wise to do so as well.”

— Gregory Horner, MD ASCA Board member, HealthPoint Ambulatory Surgery Company

ECG Management Consultants, a health care managing consulting firm based in Seattle, Washington. “If a hospital secures a value- based contract, it will need to iden- tify whether it is able to efficiently provide the services covered within that contract,” he says. “If the hospital finds that it cannot do so, it may look to purchase services locally from a lower-cost provider, such as an ASC.” As an example, he says the cost to

perform total joint replacement proce- dures is likely to be much greater in a hospital than in an ASC. “If a hospital agrees to a bundled payment for total joint replacement procedures, it may reach out to a local ASC and offer the surgery center an opportunity to par-

Seize the Opportunity While the form that value-based pro- grams take may vary between markets, Tufts says ASCs should keep their fin- ger on the pulse of value-based devel- opments in their communities and explore how they may best position their facility to benefit from changes. “To right the health care ship in this country, there needs to be a shift in the reimbursement structure,” he says. “The fee-for-service model does not incent anybody to figure out the most cost-effective care. Value-based care pressures health care providers to get very granular with their expenses and identify how to keep costs low without sacrificing quality. For ASCs, that may require them to work much more collaboratively with other pro- viders than they do today.” Horner says it is important for ASCs and their physicians to view value-based care as a positive oppor- tunity rather than a negative chal- lenge, and then take actions to help further highlight the services already provided by ASCs.

“It is time for us, as an industry,

to work together and start pulling and sharing data on the performance of our physicians and facilities,” he says. “We all know about the great work of ASCs. Now we need to show the world, particularly payers and employers, that we are saving them money beyond the profound savings we already create with the facility fee. I think that is information that could really drive incredible differentiation in the market for ASCs.”


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