ASCs to Experience Growth and Providers in Short Supply Join Sg2 at ASCA 2020 to learn more BY AMANDA OLDEROG

The Sg2 Impact of Change (IoC) forecast, updated annually, uses proprietary impact factors to project 10-year patient demand

across inpatient and outpatient services, allowing health system leaders to more accurately anticipate future opportunities and risks. Our 2019 IoC forecast indi- cates that inpatient procedure volumes will remain flat over the coming decade but all ambulatory sites, including hospi- tal outpatient departments (HOPD) and ASCs, will experience robust expan- sion. ASCs will see the highest growth but also will be challenged by provider shortages across multiple specialties. During my presentation “Proce- dure Centers of the Future: Lower-Cost, Lower-Acuity Settings” at ASCA 2020 in Orlando, May 13–16, I will discuss growth trends in the outpatient settings and the driving factors behind these trends. The timing, extent and final destina- tion of procedural site shifts will be driven by a unique blend of market and spe- cialty-specific factors that might speed up or slow down the transition to lower-cost sites of care: payer actions, provider rela- tionships (ASC ownership/employment), facility/location/infrastructure realities, technology and consumerism. When one of these factors looks to push procedures to a lower-cost site, underlying dynamics might slow that move. For example, when the Centers for Medicare & Medicaid Ser- vices (CMS) removes a procedure from the inpatient-only list, the result might not be a rapid outpatient shift; access to an ASC or inability to break even under the current payment arrangement might limit transitions. Understanding drivers of procedural shifts and service line trends allows organizations to adapt rapidly and realize significant opportunities. There is one trend, however, that crosses special-

All ASC Specialties to See Dramatic Growth

ASC Baseline Volumes with Ten-Year Growth, by Specialty US Market, 2019

% Growth

+34% Ortho

+10% Pain Mgmt

10% Other 4% ENT, 1.4M

13% Orthopedics, 5M

15% Pain Management, 6M

20% Ophthalmology, 8M

+29% Ophthalmology

Note: Percentages do not add to 100% due to rounding. Gastroenterology specialty includes endoscopy: colonoscopy; endoscopy: screening colonoscopy; endoscopy: ERCP; endoscopy: upper GI endoscopy. Pain management specialty includes procedures—minor RF ablation; procedures—minor arthrocentesis and/or injections. All subsequent service line volumes exclude GI/endoscopy and pain management volumes and are defined as procedures—major; procedures—minor RF ablations and arthrocentesis and/or injections; endoscopy; diagnostics: diagnostic catheterization. ENT = ear, nose and throat; ERCP = endoscopic retrograde holangiopancreatography; GI = gastrointestinal; mgmt = management; RF = radiofrequency. Sources: Impact of Change®

1 , 2019; HCUP National

Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2016. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2017; The following 2017 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®

, 2019; Sg2 Analysis, 2019.

ties, hits ASCs especially hard and promises to redefine ambulatory pro- cedure care: provider shortages. Robust demand for ambulatory proce- dure services combined with the increas- ing ability to disconnect from the acute- care setting increases the attractiveness of independent groups for mergers, private equity investment and payer relation- ships. Historically, “challenged” relation- ships between hospitals and independent surgeons might make hospital employ- ment unattractive to physicians, but nota- ble changes with how early-career sur- geons want to practice medicine and the rise of physician burnout signal the sta-


“Procedure Centers of the Future: Lower-Cost, Lower-Acuity Settings” will take place 4:15–5:30 pm on May 14. Review the complete schedule on the ASCA 2020 Conference & Expo website. annualconference/schedule


tus quo is not ideal. Successful organiza- tions will design sustainable systems that provide meaningful work with economic benefit and support physician quality of life through multi-faceted solutions. Examples include technology optimiza- tion, flexible scheduling, compensation and incentive agreements that support work-life balance, presence of tools to promote self-care, and physician train- ing and support for resilience, mindful- ness and work-life balance strategies.

Growth, Growth and More Growth: A Look by Specialty Dramatic and transformational growth over the next decade in the outpatient procedures space is driven by: ■

the aging, obese population; ■ technology advances; ■

improvements in anesthesia and postop care;

increased demand for access and conve- nience from Baby Boomers looking to maximize quality of life as age-related conditions become more prevalent; and

demands for value from payers, self-insured employers and patients.


Gastroenterology, 15M

% Growth

+22% GI

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