Surgeries are migrating to Ambulatory Surgery Centers (ASCs) – What does this mean for your organization?
Why is this shift happening?
Recent trends have moved an increasing number of surgical cases to the ASC setting. Medicare has removed total knee and total hip, along with several other surgical cases, from the In-Patient Only (IPO) list of surgeries. Medicare has recently gone so far as to suggest the removal of the IPO list completely. Many insurance companies have joined the migration and are requiring certain cases to be done at the ASC. The reason is that the ASC is a much cheaper place for the procedure to be completed and costs either Medicare or Insurer less for the same case. This is also consistent with the continued move towards Cost Neutral Reimbursement. The idea is that a procedure should be reimbursed the same no matter the facility or location performed.
What is the opportunity for healthcare organizations using ASCs?
ASCs stand to gain significant volume since reimbursement trends are moving so quickly to the out-patient setting. Hospitals and systems are quickly adjusting to the market shift and investing in ASCs and joint ventures. Although there are some limiting factors to ASC expansion in the short-term, such as cost of implants, organizations that can maintain volume and forecast accurately stand to significantly grow due to the trends being seen in reimbursements.
In no small part due to COVID, this process of moving procedures from in-patient to out-patient settings has been greatly accelerated. For hospital systems, it is a question of “when” rather than “if.” The challenge for any ASC will be to demonstrate the value of care provided to increase those reimbursement levels and/or to draw more surgeons to the ASC and thereby increase volume. This need for data will only increase as value-based reimbursement continues to move forward. Quality of care is a prime factor in the consideration of value, along with cost.
How can ASCs determine value in their quality of care?
To determine quality, Patient-Reported Outcomes (PROs) are the current and best quantitative measure available. ASCs can collect their own PROs for the cases done at their facilities. Providing this service for the surgeons performing cases at their ASCs would add value to the provider in joining that ASC. This data collection also serves the hospital, system, insurer, provider and patients with information on the performance of an ASC. Hospitals and systems can compare outcomes to evaluate trends, insurers can evaluate outcomes to provide changes in reimbursement levels, providers can benchmark their outcomes and choose an ASC with higher outcome scores. Patients can review outcomes that are posted or published by ASCs to determine their choice of having surgery done at a particular location.
How can we begin collecting PROs while staying flexible?
As with any initiative, how do you accomplish what needs to be done? Collection of PROs can be time-consuming and take staff time and effort away from patient care. If not performed well, collection rates can fall and the data is not as statistically valid. One solution is to engage with CODE Technology. CODE does all the collection, analysis, and reporting of PROs for the ASC or practice. Staff is able to concentrate on their roles while CODE does the work of the PROs.