The year is well underway, and 2019 already promises to be pivotal for Ambulatory Surgery Centers. Since their inception 40 years ago, ASCs have successfully worked to provide high-quality, cost-effective surgical care to millions upon millions of patients. Every year brings transformational changes to the ASC environment, and 2019 is no exception. There are number of healthcare trends ASCs need to be prepared for as they hit their 2019 stride. Here are five to consider.
Value-based care informs all other ASC trends. The shift to value-based care has pushed the steady drumbeat of cost control into a full-on march. Benita Tapia, administrator of 90210 Surgery Medical Center in Beverly Hills, CA, has one way to stay in step. She recommends surgeons use the same vendor for implants and other frequently used items. The increased volume boosts a center’s leverage to negotiate discounts.
Supply chain management is a good place to start preparing for value-based care’s impact, considering that the Centers for Medicare and Medicaid Services is finalizing its proposal to expand the definition of “device-intensive” procedures, which would allow 131 additional procedures for Medicare beneficiaries to access in an ASC setting.
Value-based care drives the next two trends shaping the ASC landscape: bundled payments and the jump in total joint replacements (pun intended).
ASCs are well suited to undertake the latest iteration of the CMS Bundled Care Payment Initiative. With bundled payments, insurers prospectively (pay providers a fixed, upfront fee for all services, with the provider held responsible for any overages incurred later), or retrospectively pay providers. Under the more widely adopted retrospective model, insurer and provider agree on a target price, then compare it to the actual cost of the procedure. Adjustments are made depending on whether or not the target price is reached.
Bundled payments help patients avoid the co-pays and deductibles of fee-for-service models, and act as an incentive for patients to choose surgery centers. Still, ASCs have been slow to adopt bundled payments. Last year, they represented only 30 percent of industry-wide payments by Medicare. They’re also the fastest-growing payment type, with a projected growth of 6 percent over the next five years.
To prepare for bundled payments, ASC managers need advanced reporting capabilities to develop the case costing and other benchmarks to monitor performance and come out ahead, as well as a claims management process that’s up to the task of submitting clean claims.
Those high deductible health plans have consumers carefully vetting and comparing the cost of various procedures more than ever before. While it’s still difficult to gain price transparency on most procedures, there are ways to separate your ASC from the competition.Some put the average price for procedures on their website. The 2019 rule hospital pricing transparency will push all other ASCs to follow suit. For example, ASCs that prioritize patient communication, and do their best to make patients feel welcomed and respected, will always score higher on patient satisfaction surveys.
Check into Becker’s ASC Review on any given day, and a state or ASC enterprise organization has signaled its jump ball time for total joint replacements. From Montana to Manhasset, NY, and Illinois to Florida, ASCs are adding total joint replacements at a fast clip. According to Vizient, the number of hip and knee replacements performed in ASCs is expected to climb 73 percent between now and 2026. Preparation for this steep climb touches every aspect of ASC operations, from getting payers onboard to recruiting the right patients to making sure front desk staff is thoroughly briefed on pre-authorization forms from payers.
These days, there are more ASCs than hospitals. At last count, there were 6,100 spread across the country. But given the value-based care trend, standalone centers must look for ways to grow case volume if they want to avoid becoming an acquisition target. Conversely, if they want to affiliate with an enterprise-level ASC chain, they must demonstrate their business and clinical operations in order to make them an attractive partner.
Here’s a development we didn’t anticipate that might become a trend. One ASC is using weekend down time to offer their center for healthcare product shoots, turning zero revenue days into positive cash flow. Now that’s an out-of-the-box idea!
Not long ago, the Laser Spine Institute closed its doors for good. The Florida-based ASC enterprise succumbed to funding pressures, unable to raise the funds needed to stay afloat during a Chapter 11 reorganization. Not planning ahead because you spend so much time on the “here and now” could put your facility at risk.
The Simplify ASC management platform has all the tools you need to manage your center today, and perhaps a few things you didn’t know you needed to prepare for the changes tomorrow will bring. It’s a simple, modern and comprehensive platform that’s designed from the ground up to work the way you do.
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