AS I SEE IT


Industry Outlook Prepare for unprecedented growth BY TERRY BOHLKE


There is no doubt the health care landscape is changing. Burgeoning health care expenditures, our aging and active population


and advances in medical technologies are fundamentally changing the way everyone views health care. Massive consolidation in virtually every sec- tor of health care is dramatically shift- ing the playing field, and these mergers have enormous implications for the ASC industry. ASCs are uniquely capable of reacting quickly to all these changes, and the ASC industry’s strategic position within this competitive health care envi- ronment will likely trigger unprecedented growth in the number of surgeries per- formed at ASCs.


Access to Care The ASC industry represents thou- sands of operating rooms (OR) across the country, serving patients of all ages. ASCs are an essential component of America’s health care delivery sys- tem and a key solution to the increas- ing demand for surgical services. The Accountable Care Act (ACA)


provides health insurance coverage through exchange markets to millions of Americans who previously did not have coverage. ASCs are an important part of providing access to patients in these exchanges, due to their capacity for high-quality, low-cost surgical ser- vices. Additionally, ACA established the Accountable Care Organization (ACO) program, which rewards ACOs for high quality and cost savings. Most ACOs have come to the realization that they need ASCs as part of their network in order to meet the cost sav- ings requirements of those programs. Even hospitals that once treated ASCs as competitors have integrated ASCs into their system.


8 ASC FOCUS JANUARY 2016


While health care is a dynamic industry and no one can accurately predict its future, it is clear that the current environment favors the ASC delivery model.”


—Terry Bohlke, ASCA


The Baby Boomer generation will significantly increase the demand for surgical services. By 2030, the number of people over the age of 65 is expected to be three times of that in 1980. Baby boomers are expected to live much longer than previous generations, be more active and have higher incidences of multiple chronic diseases. This will translate into a massive increase in demand for surgical services, a demand which simply cannot be met by the current hospital infrastructure. Since Americans have consistently rejected the idea of rationing health care, our society is left with the choice of expanding the current system or finding more efficient ways to provide the same care. The capacity available at ASCs can be an important part of the solution to this dilemma, but we must change old ways of thinking about surgery.


Quality of Care, Patient Safety and Advances in Technology Currently, the surgical care system in the US relies heavily on holding a patient overnight (inpatient) for procedures that could safely have the patient home the same day (ASC or outpatient). Total joint replacements— total knee, total hip and total shoulder replacements—are perfect examples. Clinical studies


of total


joint replacements have demonstrated significant improvements in key


patient outcomes at ASC and hospital outpatient surgery settings versus the inpatient hospital setting. Surgeons have found that patients tend to have better post-surgical range of motion and get back to their normal activities sooner when their surgery is performed in the same-day surgery setting. There are regulatory barriers that full


restrict utilization of the ASC


capacity, and one of the key hurdles is that certain surgeries are on an “inpatient only” site of service list. The site of service—inpatient hospital versus outpatient hospital versus ASC— should have more to do with risk for the individual patient based on that patient’s health rather than the procedure being performed.


Some patients require


hospitalization for a minor procedure, while other patients will be safe in an ASC for most surgeries. And many surgeries are performed as inpatient not because of the risk of the procedure but for pain control after the surgery. Advances in anesthesia, surgical techniques that produce less pain and new pain medications will continue to


increase the number of surgical


procedures that can be performed safely in an ASC. The notion that patients are safer with a list of surgeries that can be performed “inpatient only” is an outdated paradigm. Moving to a system that gives more authority for the local physician-led clinical team to determine what is best for their patient would likely result in additional surgeries at the ASC.


Bending the Cost Curve Much of the national debate around health care centers around “bending the cost curve” or curbing the cur- rent unsustainable growth rate in our health expenditures as a percent of our gross domestic product (GDP). ASCs


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