search.noResults

search.searching

dataCollection.invalidEmail
note.createNoteMessage

search.noResults

search.searching

orderForm.title

orderForm.productCode
orderForm.description
orderForm.quantity
orderForm.itemPrice
orderForm.price
orderForm.totalPrice
orderForm.deliveryDetails.billingAddress
orderForm.deliveryDetails.deliveryAddress
orderForm.noItems
FEATURE


that setting. Hospitals that embrace the ASC as a component of their overall delivery system as opposed to a com- petitor will reap the rewards.” ASCs can be the benefactor of the continued migration of cases out of the hospital, Weiss says. “As hospitals shrink, those patients are going out, and ‘out’ can be to ASCs.” ASC management should be aggres-


story “TJAs Move to ASCs” on page 10 of the August 2015 issue.) Hospital revenue is tightening due


to other factors, including reimburse- ment cuts, Weiss says. “Hospitals are feeling the squeeze, especially in areas with large Medicaid populations.” Many hospitals also are struggling


with costly operations, he adds. “Hospi- tals tend to have very large facilities and a high number of employees, which are very expensive. Many of these places are unionized, which typically adds to the expense. Hospitals have grown and become more expensive to operate as they are facing reimbursement chal- lenges. As a result, we are seeing more hospitals facing budget crises.” Hospital business practices also have


come under closer scrutiny over the past few years, Mello says. This has brought about new legislation, including a site- neutrality payment provision outlined within Section 603 of the Bipartisan Budget Act of 2015, which was signed into law by President Barack Obama in November 2015. Implementation of the provision, unless rejected, will take effect January 1, 2017. “Historically, hospitals could acquire


an ASC, convert it to a hospital outpa- tient department (HOPD) and get the associated reimbursement lift,” he says. “For health care delivery, that was not necessarily a great change, as hospital-


16 ASC FOCUS JANUARY 2017


based services often require patients and payers to pay more than they would for the same service in an ASC. In this site- neutrality


provision, the government


basically said hospitals can no longer acquire ASCs and essentially ‘flip the switch’ to change them to an HOPD.” Commercial payers are expressing similar concerns about paying higher rates than they feel are necessary, Weiss says. “They wonder why they should be reimbursing at the much higher hospital level when many cases can be done at the lower ASC level.”


How to Capitalize While hospitals work to reshape their operations to adapt to the changing times, ASCs are already positioned to benefit, Wilson says. As noted ear- lier, he says, surgery centers might find themselves pursued by hospitals dur- ing their transition. “Many hospitals and health systems are seeking ways to align or partner with ASC management and development companies to either acquire a stake in an established surgery center or develop a new facility.” Mello adds, “In light of movement


toward value-based health care, if hos- pitals start to accept fixed payments for a disease or episode of care, they are incented to provide services in the low- est cost setting. An ASC can give them


sive in its efforts to add appropriate cases, Wilson says. “Continually meet with physicians to review cases that have historically been performed in the hospi- tal setting to see which could now be per- formed in the ASC. Keep an eye on any specialties where there are still a signif- icant amount of cases performed in the hospital setting. Three great examples are higher-acuity surgical cases in spine, total joint replacement and cardiology.” This also is a prime time to explore


expansion opportunities, such as adding orthopedics and/or spine service lines, he adds. “While this is no small task, ASCs are continuing to add higher- acuity cases by developing and imple- menting clinical protocols as well as recruiting new physicians who are com- fortable performing minimally invasive procedures in an outpatient setting.” Weiss says it is likely only a matter of time before the government and pri- vate insurers reimburse procedures at the same rate, regardless of the surgi- cal setting. “In that case, there are huge opportunities for what used to be the hospital business to simply become the independent ASC business.” Hospitals are trying to evolve to cap- ture as much of this business as possi- ble, he says. Independent ASCs will need to do the same. “Just as you cannot assume hospitals will remain as they are, it would be unwise to assume the scope of procedures being performed in ASCs will remain as it currently exists. ASC physicians and investors should keep a continuous eye open for what procedures are coming out next, espe- cially as technology changes.”


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30