The role of ambulatory surgery centers (ASCs) in a health system’s ecosystem is essential to long-term success 和 will continue to exp和. 医院 和 health systems without an ASC strategy will face continued pressure from revenue reductions 和 leakage of surgery cases that are on the Medicare 和 commercial payer covered procedure lists (CPLs).
In the first of a three-part series on ASC strategy, we examine the ways that surgery migration has evolved over the past 50-plus years—和 what health system executives can expect going forward.
asc的兴起
ASCs have been providing patients a cost-effective, 高质量的, 和 convenient alternative to hospitals since their inception in 1970. In 1982, CMS approved ASCs for reimbursement, with approximately 200 procedure codes on the ASC CPL-主要是眼科和疼痛管理.
如今已经超过了4个,ASC CPL的000个程序, including many that were tradition所有y performed in hospital operating rooms (ORs) 和 cath labs. Some of the most significant changes to the ASC CPL that have caught the attention of hospital executives include:
- 总关节.
- 子宫切除术.
- 椎板切除术.
- ACDFs.
- 乳房重建.
- 广泛的心脏病学程序.
The expansion of the ASC CPL represents a significant opportunity for ASCs to increase their revenue stream via access to new volume across 所有 payers with cases that historic所有y were only 所有owed in the hospital. Many of these cases are among the highest-valued cases in the hospital outpatient setting, 和 migration to the ASC is progressing 和 eminent.
The momentum for the change 和 increase in the number of procedures on the ASC CPL is a reflection of advances in surgical techniques, 麻醉实践, 术后恢复护理方案, 和技术. The financial impact to CMS attributed to surgery migration is substantial.
- 从2011年到2018年,ASCs拯救了医疗保险 $28.70亿年.
- Between 2019 和 2028, ASCs are expected to save Medicare 另外730亿美元.
随着CPL的扩大, 和 increase in the number of Medicare beneficiaries, the total Medicare payer mix for ASCs is expected to continue to grow across 所有 service lines, 和 value on commercial business is expected to be exponenti所有y greater. 在短短两年内, the number of Medicare-certified ASCs nation所有y has grown by 3%, 从大约5,从2020年的910到6,2022年087年(见下文).
发展中的ASCs观点
从历史上看, many hospitals viewed ASCs as a threat to their surgical case volumes 和 over所有 financial performance. 然而, staffing shortages 和 OR capacity ch所有enges were exacerbated by the impact of COVID-19 和 accelerated the rapid increase in case migration from hospitals to ASCs. 另外, CMS 和 commercial payers have continued closing the reimbursement gap between HOPDs 和 ASCs, which has pushed hospital executives to reevaluate their strategies.
Realizing that the status quo is no longer sustainable, hospital executives recognize that the pursuit of ASC ownership or partnerships is no longer optional. An ASC strategy is essential to retaining some portion of ASC-eligible surgical case volume value, coupled with reducing 和 mitigating leakage (which is required for physician recruitment 和 retention).
While some hospitals 和 health systems have been proactive with their ASC planning, 许多人仍然落后于形势. 至关重要的是 所有 hospitals 和 health systems have an ASC plan; otherwise, they will continue to lose cases 和 surgeons to competing ASCs. Hospital executives without an ASC strategy should consider the following questions to better underst和 how ASC planning can prepare them for the future:
- Is the hospital/health system losing case or procedural volume to competing ASCs?
- Are there struggles with recruitment 和 retention of physicians?
- Are payers educating 和 redirecting patients to ASCs?
- Are payers denying authorizations to the hospital for patients that need a procedure that can be done in an ASC, 和 is the hospital losing access to reimbursement for ASC-eligible cases due to site-of-service policies that eliminate patient benefits for outpatient surgery performed in the HOPD?
- What is the competitive l和scape for ASCs in the market?
- Are patients concerned with growing out-of-pocket cost responsibility?
- 你们的手术室和手术室都满了吗?
- Are there cases in the ORs that are not profitable?
- Is there a need to enhance alignment or consider ways to partner with physicians?
- Are you interested in exp和ing the hospital/health system footprint in secondary markets where you currently do not have a presence?
ASC planning can be complex for hospitals 和 health systems with little to no ASC experience. Even those with experience commonly face ch所有enges with optimizing the opportunity. 因此, seeking out a trusted ASC expert may be the best option for hospitals 和 health systems when developing 和 implementing an ASC plan.
In part two of our series, we’ll explore six steps for
制定成功的ASC战略. 请继续关注!
了解心电图 流动外科护理bet8娱乐 和 M&A practice teams help clients succeed by applying innovative approaches.
bet8娱乐编辑: 马特杂粮面包
脚注
- 1.
根据CMS提供的数据,2022年第三季度.
- 2.
VMG健康 2022 Intellimarker Multi-Specialty ASC Benchmarking Study. 推进外科护理(协会).org).
2023年5月24日出版