Growth Expected for ASCs Gynecologic, orthopedic and gastroenterology procedures will continue to shift to surgery centers BY MIRANDA K. KELLY

ASCs are expected to grow in

popularity in

the coming years. This growth is the result of several factors.

Lower Cost, Greater Convenience First, ASCs remain a lower cost alter- native to the hospital setting and play a role in the increasingly consumer-driven nature of healthcare. Patients and payers alike favor ASCs as a lower cost, more efficient and convenient alternative to inpatient procedures.

Second, technological advancements continue to allow more procedures to be performed in the ASC setting compared to several years ago. With technological improvements, more and more complex surgeries are expected to move out of the traditional hospital setting and into ASCs.

Better Technology, More Outpatient Specialties In line with these technological advancements that allow complex sur- geries in an outpatient setting, certain specialties are expected to become more popular in the ASC space. More and more focus is being placed on oph- thalmology surgery centers. LASIK and other types of laser vision cor- rection procedures have grown over the past three years with more than 843,000 procedures performed in 2018, according to the Refractive Sur- gery Council. This, along with a grow- ing need for more cataract procedures from the aging Baby Boomer popu- lation, have contributed to the rise of ophthalmology surgery centers. Gynecologic procedures, including

hysterectomies, also are shifting away from the inpatient setting and into ASCs.

As CMS continues to revise rules on payment and regulatory matters to increase transparency and flexibility for consumers and providers, expect ASCs to expand the range of services they offer and the share of the patient market they serve.”

—Miranda K. Kelly, Waller

Additionally, orthopedics and gastroen- terology remain popular ASC specialties. As the Centers for Medicare & Medicaid Services (CMS) continues to remove certain high-revenue pro- cedures from the inpatient-only list, those services, such as knee replace- ments, coronary artery grafts and the implantation of carotid sinus devices, are likely to gain popularity in outpa- tient settings. Specific revisions to the list by CMS are available on CMS’ outreach and education site.

New CMS Rule Reduces Regulatory Burden for ASCs In late September, CMS released a final rule that aims to reduce regulatory bur- den by “removing unnecessary, obso- lete or excessively burdensome Medi- care compliance requirements for healthcare providers and suppliers.” More specifically, the new rule eliminates hospital transfer agreement requirements, changes the medical his- tory and physical assessment (H&P) requirement, and changes emergency preparedness rules. These changes could bring significant benefits for ASCs.

Under the new rule, ASCs will no longer be required to have hospital transfer agreements or need to make certain that all physicians practicing in the ASC have hospital privileges. Instead, ASCs will only be required to provide local hospitals with periodic notices of operation and the patient population being served.


ing to ASCA, this change “will alle- viate the administrative burden of negotiating or being denied negotiat- ing opportunities associated with the written transfer agreement between the ASC and hospital.” Additionally, the rule replaces the

existing medical history and physi- cal assessment requirement with a requirement that ASCs adopt policies to identify the patients who need such an exam and the timing of those exams. Ultimately, this should streamline the pre-operation process for patients and providers and ensure that the results of all pre-surgical assessments are added to a patient’s medical record. Finally, ASCs will now be required

to review their emergency plan every two years rather than annually and will have to conduct only one testing exer- cise per year rather than two. In addi- tion, if a facility has to deal with an emergency, it is then exempt from the next required exercise. Turn to page 24 for more details on the rule. Altogether, the outlook for ASCs for the remainder of this year and into the future looks positive. As CMS con- tinues to revise rules on payment and regulatory matters to increase trans- parency and flexibility for consumers and providers, expect ASCs to expand the range of services they offer and the share of the patient market they serve. For more information on the most recent rule, click on the “Federal Reg- ulations” tab on ASCA’s home page

Miranda K. Kelly is a partner at Waller in Nash- ville, Tennessee. Write her at miranda.kelley@

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion. ASC FOCUS JANUARY 2020 | ASCFOCUS.ORG 15

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