ASCs and Post-Acute Services Skilled nursing facilities would work with surgery centers BY ROBERT KURTZ

Andy Whitener is the chief executive officer and administrator of Gaines- ville Surgery Center in Gainesville, Georgia, an affiliate of Surgical Care Affiliates. Write him at

Q: Why might ASCs and post-acute ser- vice providers make good partners? AW: Procedures once considered too complicated for ASCs, such as total shoulders, anterior cervical disc fusions, total hips and knee replace- ments, are becoming commonplace. When ASCs start to perform these pro- cedures, they must take into account the services required following surgery, such as physical and occupational ther- apy. ASCs have opportunities to gain efficiencies by examining where these services would be provided most effec- tively and cost-efficiently. In an effort to educate myself about post-acute services in my area, I serve as a community member on a home health board and meet with skilled nursing facilities (SNF). What I have found is that these providers are pursu- ing new business lines and are willing to think outside the box. Several of the SNFs I met with are open to providing the post-acute ser- vices my ASC needs. SNFs have seen their skilled admissions decrease with the growing popularity of the anterior approach for total hip replacements. Those patients, who used to spend some recovery time in an SNF, are now going home.

ASCs performing more com-

plex procedures could benefit from accessing the existing services of an SNF. SNFs are prepared to monitor vitals, address pain and feed patients and do so at a satisfactory payment rate. SNFs may be willing to take on


ASC who would benefit from contin- ued observation and care. Any SNF already provides food

services, and some of the facilities are capable of addressing pain and recog- nizing urgent situations.

ASCs performing more complex procedures could benefit from accessing the existing services of an SNF.”

— Andy Whitener Gainesville Surgery Center

the added responsibilities and meet the standards of care our ASCs and patients expect. The need for such coordination is increasing as the types of cases performed in an ASC become more complex.

Q: What is an example of a post-acute provider partnership an ASC might consider? AW: The example that

I think has

potential is for an ASC to contract with an SNF to provide observation care to those patients recovered at an

Q: What are some important con- siderations ASCs must take into account before exploring this type of arrangement? AW: The ASC would need to develop an agreement with the SNF and address non-emergent transportation and pro- tocols for how to deal with poten- tial issues. Insurance companies will need to be included in the discussions, whether they were to pay the SNF for services or if the ASC were to make the payment. Liability will need to be addressed. Documents must be created to inform the patient of the possibility of an overnight stay in a nearby facil- ity, and processes and documents must be created to provide for a smooth clin- ical transition. All providers will need to keep in mind that quality is the ticket to suc- cess going forward. The percent of Medicare payments tied to quality is predicted to rise to 90 percent in 2018 [according to https://innovation.cms. gov/initiatives/Health-Care-Payment- Learning-and-Action-Network/], and private payers will follow. ASCs play an important role in

improving the value of health care. Working with post-acute service pro- viders is a way of becoming more patient-centric while maintaining our promise to deliver high-quality, low- cost care.

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