COVER STORY
ASCs in ACOs
How to be successful in the coordinated care model BY SAHELY MUKERJI
A
ccountable care organizations (ACO) are a growing reality, but
most ASCs are not affiliated with an ACO yet. “So far there is a relatively small number of ACOs nationally, some doing better than others,” says Randy Todorovich, RN, CASC, senior vice president of managed care at ASD Management in Valencia, California. “Over the next two to three years there will be major expansion and growth of ACOs. The challenge for ASCs will be to be part of that process.” It is a good idea for ASCs to level- set and see how they fit in best in the ACO model, says Marian Lowe, senior vice president of payer and employer strategies at United Surgical Partners International in Addison, Texas. “The market started consolidating before ACOs came on to the scene and that trend seems to be continuing. In addi-
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tion, the number of patients now shop- ping with high-deductible plans has increased, so patients have become more price-sensitive.” Todorovich agrees. “It makes a lot of sense for an ASC to be part of the ACO, dollar wise and quality wise. In an ACO model, you want high quality and low cost, and being outpatient, it fits our model perfectly. In the short- term, the hospitals will drive the mod- els, because the long term is uncertain. We are in a couple of ACOs, mainly because we are part of a hospital.” Donna St. Louis, vice president of
ambulatory service at BayCare Health System, Tampa Bay, Florida, says her health system is currently applying to be in an ACO. “ASCs should want to be part of an ACO,” she says. “We cur- rently have a clinical integrated net- work (CIN) in our market. We will
be part of the solution because of our affiliation with our ACO. “ASCs should be more attractive
to ACOs because their rates are less than hospital outpatient department (HOPD) rates,” she continues. Those lower rates, she cautions, could cause concerns for ASCs as well, especially in Florida—a very competitive state that does not require certificates of need (CON). “My concern is that inde- pendent ASCs will go out and negoti- ate low reimbursement to attract ACO patients to their facilities and this could have an impact on the ASC industry.” Stand-alone ASCs might find it harder to find a place in the ACO market than corporate-owned ASCs, St. Louis says. “We have a larger market share, so it will be tougher for the smaller ASCs. On the other hand, if you compare my multi-specialty center with a single-specialty GI center, their prices for a colonoscopy will probably be lower than my center’s because they don’t have our overhead costs. So how an ASC works
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