Becker's ASC Review

20 ASC MANAGEMENT AHA fights site-neutral payments for HOPDs with new study By Laura Dyrda T he American Hospital Association is challenging CMS's 2019 payment reduc- tions to off-campus hospital outpatient clinic visits, and the move toward site-neutral payments, with a new study that claims patients at hospital outpatient departments are poorer and sicker than ASC patients. Seven things to know: 1. When CMS released the final rule in No- vember 2018, ASCA applauded their move- ment toward site-neutral payments. e new policy could save Medicare $380 million this year by dropping reimbursement around 60 percent. 2. KNG Health Consulting conducted a study for the AHA comparing patient populations at HOPDs with ASCs. e study found HOPD patients are more likely non-white, dual eligible, from lower-income areas, have more severe chronic conditions and reported previous hospitalization than the ASC's patient population. 3. e study found around 47.4 percent of Medicare patients at HOPDs are between the ages of 65 and 74 years old, compared to 56 percent of ASC patients. However, 8.2 percent of the Medicare patients at HOPDs were 85 years old or older, compared to 6 percent of ASC patients. 4. ASCs reported 52.8 percent of their patients had at least one chronic condition, compared with 66.6 percent of HOPDs. Pa- tients at HOPDs were also more likely to have at least one major chronic condition, with 23 percent reporting a major chronic condition, compared with 13 percent of ASCs. 5. e study authors concluded, "Due to their higher medical complexity, HOPD patients may require a greater level of care than ASC patients." 6. CMS reduced payments for off-campus HOPD clinic visits under the 2019 outpatient prospective payment system final rule, which led to the AHA and Association of American Medical Colleges to join three hospitals in filing a lawsuit against the agency. e AHA alleges Medicare already reimbursed HOPDs less than the cost of care; Medicare's margins for outpatient services in the 2017 fiscal year were -12.8 percent. "Physicians tend to refer more complex patients to hospital outpatient departments for safety reasons, as hospitals are better equipped to handle complications and emer- gencies," said AHA President and CEO Rick Pollack. "Proposals that treat hospital out- patient departments the same as ambulatory surgical centers and other sites of care are misguided, and ignore the healthcare needs of the patients and communities we serve." 7. AHA and KNG Health have also worked together on studies that show similar out- comes between hospitals and independent physician offices to argue against lowering payments for similar services in the hospital setting. n The strategy for 4 ASCs to recruit and retain a great staff By Laura Dyrda F our ASC administrative leaders discuss how they are solving their biggest staffing challenge: recruitment and retention. Peter Graf. Business Manager for the Center for Pain Control and Wyomissing Surgical Services (Read- ing, Pa.): Competing with the local hospital for quality employees at a competitive salary is our biggest staffing challenge. It is difficult finding the right staff when the job descriptions differ from our ASC compared to the local hospitals, yet we have to offer similar compensation pack- ages. We are currently a single-specialty ASC and offer other benefits such as no night calls and no weekends. It is our hope that the other advantages will be taken into consideration by prospective applicants. Lara Herndon. Regional Director of Operations for Prime MSO (Glendale, Calif.): Retaining staff has been difficult for us as a company. We have expended a lot of time, energy and resources training staff, i.e., AORN's Peri- op 101, only to have them leave us after their one-year commitment expires. Many of the nursing staff members leave for acute care facilities that are unionized and offer a far larger base salary that we can as independent ASCs. Melissa Rice. Administrator of Hyde Park Same Day Surgicenter and Illinois Anesthesia Specialists (Chi- cago): Our biggest challenge is finding candidates to come to the center. Location is key and for us we are not in an ideal area. We have resorted to using agency nurses. We definitely have a family atmosphere at the center. We spend more time together than with our families, so keep- ing things light and communication open and flowing has helped. Patrick Garman. Executive Administrator of Spartan Health Surgicenter (Monongahela, Pa.): Spartan's big- gest staffing challenge has been finding the qualified clinical staff member who is willing to be compensated what a typical ASC can pay versus what that same clinician will be compensated for comparable work at a hospital. Recruiting and retaining solid part-time/per diem nurses and operating room techs, weaving them into the sched- ule so that it benefits the ASC is a challenge. These part- time/PRN clinicians enable an ASC to reap considerable profits due to flexibility, mobility and expense savings. n

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