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This is no time for ASCs to be stagnant. Competition is heating up, for everything from physicians to cases and staff to supplies. Such a rise in competition comes as no surprise considering the rapid growth ASCs experienced over the past several years and the projected growth centers are projected to experience in the coming years, as reported on by the likes of ASC Focus, Outpatient Surgery Magazine, HealthLeaders, and many other publications and organizations. Surgery centers not looking for and pursuing avenues to improve their operations and performance may find themselves playing an impossible game of catchup if other surgery providers in their market capitalize on such opportunities.
That’s why we’re increasingly seeing more ASCs making decisions and investments that are accelerating strategic plans, solidifying and often expanding market positions, and strengthening appeal to stakeholders — all of which are allowing these aggressive centers to not only maintain their reputation as leading surgical providers but also better ensure they remain leaders in the future.
Let’s look at some of the ways surgery centers are transforming themselves from the ASCs of today into the ASCs of tomorrow.
Did you know some ASCs have been performing total joint replacements for decades? CMS added total knee and total hip replacements to the ASC covered procedures list over just the past few years, which has helped spur development of new ASC total joint programs nationwide. However, some surgery centers have performed these procedures on non-Medicare patients since at least the 1990s. These centers secured contracts with commercial payers for coverage of the procedures by showing quality and outcomes data. Some centers offered a cash-pay option for patients who would not be filing the procedure to their insurance.
While Medicare coverage of procedures helps bring commercial payers on board with providing their own coverage, forward-thinking ASCs aren’t waiting to bring non-Medicare-covered procedures into their centers. They’re examining what procedures their surgeons are safely performing on an outpatient basis — or could be on an outpatient basis — and delivering great outcomes and working to migrate those procedures to the ASC. With commercial payers becoming more receptive to covering ASC procedures, surgery centers that pursue these opportunities are being rewarded with new patient volume and service lines that also have the potential for significant growth as the outpatient migration of procedures continues. Furthermore, adding new procedures and service lines will take on increased importance for ASCs as lower-acuity procedures continue to migrate to office-based surgical practices.
As surgical volume has steadily shifted from the inpatient to the outpatient setting, medical device and equipment manufacturers have taken notice. They have developed new clinical technology and product lines largely targeted at ASCs and have also taken existing clinical technology previously marketed to hospitals and adjusted features and pricing to better appeal to ASCs. We’ve also seen a host of new companies form, often with surgeon leadership, and launch new devices and equipment designed for outpatient surgery.
ASCs working to better their position in the market, grow their case volume, and enhance their appeal to new surgeons and patients are investing in these emerging clinical technologies. Robots/robotics is one such example. This technology used to be cost-prohibitive for nearly all ASCs. Now, with prices of older models coming down and companies developing models with surgery centers in mind, we’re seeing more robots make their way into ASC operating rooms. This is helping ASCs launch and grow new service lines.
While robotics is still too expensive for many surgery centers, that’s not preventing investments in other clinical technology. A recent ASC Focus article provides examples of newer medical technology in use at ASCs, including an upper airway stimulator, navigation/image guidance, sinus balloon, and an implantable steroid embedded into a dissolving material. In some instances, new technology can help an ASC better perform existing procedures. In other instances, the investment in the clinical technology brings with it entirely new procedures and can help bring in new surgeons and patients.
ASCs have earned a reputation for being slow adopters of IT. One of the reasons surgery centers have generally trailed behind other provider types like hospitals and practices for IT concerns the passage of the Health Information Technology for Economic and Clinical Health Act in 2009. The HITECH Act essentially represented the beginning of federal government money going to providers to support and encourage IT adoption. While hospitals and practices received those dollars, ASCs and some other provider types did not.
But the value and importance of IT has only accelerated since the passage of the HITECH Act, which has led to a steady uptick in adoption of IT systems. While much of the attention in this area goes to ASCs adding electronic health record (EHR) systems, surgery centers looking to take further advantage of the benefits of IT are adding other types of solutions that are allowing them to make smarter equipment and supply purchases, streamline payment processes, enhance stakeholder communication, better manage inventories, improve billing and collections, and more. Such investments are helping centers move away from manual and paper-based processes that bring with them costly inefficiencies and cause ASCs to miss improvement opportunities and move toward automation and streamlining the completion of responsibilities and projects. This supports efforts to better navigate the ongoing issues of staffing uncertainties and cost increases while also helping ASCs achieve improvements in performance, efficiency, and productivity.
FFS has long been the traditional and dominant payment model for healthcare services, including those provided by ASCs. While FFS is likely to remain the most common way surgery centers are reimbursed for some time, there’s considerable momentum behind alternative payment models (APM). This includes value-based care models (e.g., bundled payments and pay for performance), direct-to-employer contracting, and self-pay patients.
We’re seeing a growing number of surgery centers pursuing one or more of these APMs through a variety of strategies, including engaging in discussions with payers, employers, and other providers in their markets and developing and publicizing cash prices. By doing so, centers are securing new — often lucrative — contracts, entering into partnerships that can grow their patient and case volume, increasing their revenue, and ultimately better positioning themselves for a future that’s likely to continue moving away from FFS.
The pressures facing ASCs mean simply performing a lot of procedures does not necessarily translate to financial success. Reimbursement has tightened greatly, and costs have risen rapidly over the past several years. It’s increasingly difficult — and expensive — to acquire all the supplies needed to perform procedures. While surgery centers are still a desirable place of employment, recruitment and retention have proven more difficult largely due to the competition mentioned earlier — competition that can often offer higher salaries and stronger benefits.
To succeed in this challenging environment, ASCs must continue to perform those best practices that have long been identified as crucial to longevity. These include case costing, benchmarking, effective block scheduling, recruiting new physicians, adding procedures, and succession planning. But now we are seeing centers looking for opportunities for improvement that go beyond the tried and true, some of which are targeted at pressing challenges. A few examples:
The final way ASCs are transforming themselves that we’ll highlight concerns marketing. Surgery centers have often left marketing to their affiliated physicians and practices. After all, most patients end up at an ASC via referral from a surgeon. The thought for ASCs was that as long as their physicians had well-performing practices, the center should have consistent surgical volume. While this generally remains the case, we’re seeing more ASCs recognize the value of marketing themselves.
Effective marketing can help surgery centers in numerous ways. It can put a center on the radar of a physician looking for a location to bring cases. It can help build awareness of job opportunities and demonstrate why a center is a desirable place to work. Marketing can enhance the appeal of an ASC to a prospective strategic partner, such as a hospital or management company. Marketing can also enhance appeal to a large employer in the market looking to contract directly with providers. If an ASC offers a cash-pay option, marketing is critical to building awareness of the program and attracting patients. Even if an ASC only takes insurance, marketing showcasing good outcomes, positive reviews, high levels of patient satisfaction, and a friendly staff can motivate patients to ask their referring surgeon if they can go to a specific center.
The COVID-19 pandemic may have hurt ASCs, especially during the initial months of the public health emergency, but surgery centers now find themselves in a very strong position. The migration of surgical cases from inpatient to outpatient settings has accelerated, and ASCs are the most logical facility type for most of these procedures. Patients are looking to avoid hospitals and want the convenience and cost-effectiveness surgery centers offer. The same can be said for a growing number of payers, employers, and many surgeons. ASCs are finding themselves increasingly approached by hospitals and health systems, management companies, and the occasional private equity firm interested in acquisitions and investments.
One thing is clear: The surgery centers that will benefit most from tailwinds and most effectively navigate headwinds are those evolving with the times. These will be those centers that are more aggressive with undertaking initiatives and investments to improve their operational, clinical, and financial performance. Meanwhile, ASCs that hope to continue with “business as usual” may find in a few years this approach has left them with a business that’s unusual — and not in a positive way.
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