Becker's ASC Review

23 Thought Leadership 17. Surgery center revenues are highly dependent upon two things: the number of procedures that they are doing and the reimbursement per procedure. Surgery centers remain greatly reliant on ophthalmologists, gastroenterologists, orthopedic surgeons, pain management surgeons and the rest of the surgeons that use surgery centers. ASCs are greatly reliant on doctors remaining at least partially independent. 18. Over the last decade, 80 percent or so of physicians that are primary care physicians have ended up employed by hospitals or other organi- zations. However, only 30 percent of the procedural driven specialists have ended up employed. e surgical community has remained much more resilient to employment than probably expected. is has been a huge saving grace for surgery centers. 19. On the reimbursement side, Medicare reimbursement has stayed relatively solid, about that same as it was with small inflationary in- creases but generally fine in certain specialties for surgery centers. On the commercial side, years ago there were drastic cuts in commercial reimbursement. More recently there is not as much of that. 20. If an ASC is an out-of-network center or heavily reliant on workers compensation, then it may have much more risk of big reductions in reimbursement. n 4 ASC experts weigh in on 2020 trends By Rachel Popa Four 2020 business trend predictions from ASC leaders: Note: Responses have been lightly edited for style and clarity. Cami Love, administrator at the Arkansas Specialty Sur- gery Center in Little Rock: "I think [total joints are] something that's going to continue to grow. Our first total joint procedure was a knee. We've already started on the process to do shoulders. And then the next thing we'll tackle will be hips. I really think starting a successful total joint program will help with getting carve- outs from other insurance providers as well. Then that will pave the way for more ASCs to do it and have good results. We're in a very low reimbursement state. We were a little disappointed that Medicare's reimbursement was low for total joints. Something we're constantly working on in Arkansas is to get better reimbursement for orthopedic pro- cedures that have a lot of implants and disposables which are bundled. We're trying to get more carve-out to help cover some of the big, expensive supply-heavy cases that are cost-prohibitive due to reimbursement." Anthony Giuffrida, MD, director of interventional spine and sports at Cantor Spine Institute in Fort Lauderdale, Fla.: "The ASC is where medicine is going. The cost of being in the hospital is just too great to sustain. A three-level fusion and a few days in the hospital costs the healthcare system upward of $70,000 to $100,000. A three-level Intracept procedure will cost $10,000 to $15,000 in the outpatient setting. We're cutting costs in the ASC by over 50 percent. If we can make the process easier and less painful for the patient and decrease cost, that's a win all around. There's going to be a huge push for outpatient surgery the next five years, and we're going to see great things from it. The one thing we have to remember is we have to keep safety in mind always. You have to pick the right patients." Scott Fowler, MD, president and CEO of Holston Medical Group: "The business of medicine is moving to outpatient. Many health systems are generating a lot of their revenue from outpatient service lines, and many hospitals and health sys- tems shifted service lines from inpatient to outpatient. Part of that is because the revenues received in the outpatient marketplace are high enough and maintainable. That said, consolidation of hospital systems gives ASCs more market power and control of the outpatient market space — which is the market of the present and future. For example, in southwest Virginia and northeast Tennes- see, hospitals began partnering in outpatient settings with some national payer-related management companies. By doing this, higher rates are impacting the community, more than what was previously being charged in the outpatient marketplace — making inpatient facilities more competitive in terms of pricing and keeping the overall price high." Mara Holton, MD, of the Anne Arundel Medical Center: "The question of price transparency is inextricably linked to the most pressing issue facing independent physicians today: the increasing rate of hospital consolidations and mergers, including acquisitions of independent practices across the country. President Trump's mandate toward value-based care makes it imperative that initiatives nurture independent practices as the most fecund incubators of innovative and efficient mechanisms for delivery of care. This executive order will help foment a competitive healthcare marketplace that enhances opportunities to recognize and expand the provi- sion of value-based and cost-effective care.' n "The ASC is where medicine is going. The cost of being in the hospital is just too great to sustain. A three-level fusion and a few days in the hospital costs the healthcare system upward of $70,000 to $100,000." - Anthony Giuffrida, MD

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