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FEATURE


be done for a much lower price than had they been performed in a hospital.” Rosenbaum is also seeing increasing pressure for the movement of some pain management cases out of the office and into the ASC. “Office-based pain physi- cians are looking to partner with other pain groups that have access to an ASC. It is not only a much better patient envi- ronment, but the site of service reim- bursement for many office-based pain procedures has seen a significant reduc- tion. In the ASC, some of those same procedures did not get the reimburse- ment cut or maybe went up a little bit. I think that is the government’s way of saying these procedures should be done in a more regulated environment.”


Market Consolidation Providers are facing growing expenses, which is also affecting ASCs nation- wide, Gary says. “One of the con- sequences of health care reform is more of a push toward consolidation as people try to determine if a larger size affords them negotiating leverage with respect to expenses and, perhaps, opportunity to run more efficiently.” This consolidation is taking shape in a number of ways, Tanner says. “Surgeons are seeing their primary care doctors increasingly employed by hospitals, so I think the referral base for ASC physicians will be more chal- lenged going forward.” More ASCs are finding themselves


targeted for acquisition by hospitals— an unintended consequence of the PPACA, Tanner notes. “We are seeing . . . ASC physicians increasingly will- ing to sell, in part because of fear of a shrinking referral base.” This is unfortunate, he says, as hospitals are frequently converting these ASCs to hospital outpatient departments (HOPDs). “This has a huge negative impact on at least the cost of care because it is the same surgeon using the same equipment performing the same procedure, but it is now in an HOPD.


14 ASC FOCUS FEBRUARY 2015


Health care reform has essentially forced everyone, including the health care consumer, to become cost conscious.”


—Stephen Rosenbaum, Interventional Management Services


HOPD rates are typically about double what we get paid in the ASC. ASC growth has definitely slowed for the past two years, and I suspect it may have even gone down as a result of hospitals acquiring ASCs and converting them.” Tanner says hospital acquisitions


of ASCs and other factors, such as increasing provider costs and reg- ulatory requirements, are having another effect that should be a con- cern for ASCs: the threat to physi- cian independence. “ASCs, for the most part, are


dependent upon independent physi- cians willing to invest their time and money to build an environment where they can deliver high-quality care at a reasonable price,” he says. “We are seeing physicians increasingly consid- ering surrendering their independence because they just cannot visualize a future where they can afford to do what they do independently.”


Consolidation, however, might present an opportunity for ASC physi- cians to maintain their independence. “I have been working with physicians across the country to help them con- sider ways to unite into larger groups. This not only allows you to share ser- vices and some of the expenses of being an independent physician, but if you can assemble a critical mass, you will be in a better position to challenge payers to work together with physi- cians to identify a shared set of goals for both parties. “We need to change the dynamic— to stop going to the payers and begging for more money, but instead, find a way to work collaboratively with the payers to identify these shared goals and then participate in the shared savings we can generate together,” he says. “If the tip of the sphere is focused on quality and delivering patient care at a reason- able cost, then I think you can create a win-win situation.”


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