Becker's ASC Review

29 Thought Leadership An election won't solve healthcare's biggest problem, says former Sen. Bill Frist By Eric Oliver F ormer Republican senator for Tennessee Bill Frist, MD, offered his opinion on the big- gest issue threatening healthcare today and elaborated on what the electorate wants from legislators going into the 2020 election. Note: Responses were edited for style and content. Question: Healthcare is a tumultuous issue in the 2020 election. What do you view as the biggest problem in healthcare and what would you do to fix it? Dr. Bill Frist: The biggest challenge facing healthcare entities won't be an election issue, and it's not on the radar of healthcare consumers. It's the risk of cyberattack, and it extends well beyond stealing patient records or financial extortion. The potential is massive patient and clinical care disruption. Lagging behind financial and retail industries in implementing cyber defenses, the increasingly digital and connected healthcare sector is increasingly becoming a target of cyberattacks. From shutting down intensive care room monitoring, inter- fering with pacemaker settings, to literally turning off the lights in the operating room, the risk is monumental. This past December, HHS issued voluntary cybersecurity guidelines for the healthcare sector to help reduce security risks. Each of us should thoughtfully and regularly address this constantly moving and ominously growing challenge. Q: Universal healthcare is a sticking point in the elec- tion. What are your thoughts on the matter, and what do you think legislators need to do on the issue? BF: Obamacare was about access — or universal care. That was yesterday. The issue today is cost and the inefficiencies and hassles that drive it up for the average person. Voters on both sides of the aisle consistently list their top health- care issue as lowering the amount they pay out of pocket for healthcare. They are demanding solutions that reduce the pocketbook squeeze. These cost and access issues are the most popular topics on my new podcast, which views healthcare challenges at the intersection of medicine, policy and innovation: "A Second Opinion: Rethinking American Health with Senator Bill Frist, M.D." The words "Medicare for All" are now deeply embedded in the political narrative for 2020, though the expression means different things to different people. For example, Bernie Sanders' plan creates a totally government-administered, single-payer system eliminating all private health insurance (the most expensive of the proposals to the government), while Joe Biden announced a "Medicare for All-LITE" ap- proach that would create an optional Medicare buy-in on the ACA exchanges. Experienced policymakers [believe] the Sanders approach will never make it through the legislative process. Legislators will concentrate on what the voters want today: affordability and convenience. n (Continued from page 28) If the physicians aren't comfortable performing these procedures in an ASC setting, the capital expenditures conversation isn't worth hav- ing. Q: What should ASCs expect from CMS in the coming years? JD: I think that with CMS' demonstrated willingness to expand the library of cardiology CPT codes available to ASCs, we will see more codes and procedures to follow. However, it is tough to say when. Governmental agencies aren't known for taking quick action, which is sometimes a good thing. It is no secret, at least to those that read trade publications like Becker's ASC, that ASCs are a very safe place for patients to have important and increasingly higher acuity surgical procedures. I doubt that we will see CMS open up a fire hydrant of CPT codes in the next year or two, but it is probably safe to assume that if we continue to safely perform these procedures, the data will eventually speak for itself and drive future expansion of the specialty. Q: Do you see cardiology as a growing specialty for ASCs? JD: Absolutely. But, same as any other disruption to an industry, it will require a change in strategy. ASCs have been built around orthope- dics, ENT, podiatry and other specialties. Cardiologists don't generally mingle with this crowd since they are holed up in the cath lab all day. Nearly every cardiologist I have spoken with about coming to one of the ASCs we manage has said, "Hmm, I've never thought of that before." If the lab is full, then many hospitals push generator changes to the end of the day at the main OR, not exactly a preferred time for surgery. e frustrations encountered on a daily basis by interventional cardiologists and electrophysiologists over this kind of treatment is, frankly, a huge gi and a door-opener for the ASC industry. Once we have the ear of these providers, the opportunity to bring them in to the ASC indus- try in a big way is dependent upon us being able to provide a level of patient safety and physician comfort that they are accustomed to seeing at the "big house." is shouldn't be out of reach, since ASCs typically offer higher nurse-to-patient ratios and lower infection rates, in addi- tion to being more efficient with time. It is no different than it is or was with any other specialty. You need to find a team captain that is willing and able to provide their insight and enthusiasm to build a vibrant and successful cardiology program in your ASC. n

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