Becker's Spine Review

40 ASC The ASC winners and losers in 2022 By Laura Dyrda T he next year will be pivotal for ASCs as the pandemic continues to strain healthcare providers and competition for waning dollars heats up. Twelve thoughts on which ASCs will win, and which could lose, in the next year: Winners 1. ASCs with the ability to scale up high-acu- ity cases such as total joint, spine and cardi- ology will be in a better position to capture these cases as CMS and other payers begin directing patients to the ASC. 2. Surgery centers with sophisticated data gathering and analysis capabilities will be well-positioned to take advantage of their value proposition in payer negotiations and ready to take on value-based contracts. ey can also use clinical and cost data in di- rect-to-consumer marketing campaigns. 3. e ASCs with strong leaders and a great established culture will be attractive to nurs- es who may be willing to take a slight pay cut for a better work-life balance. Labor shortag- es will continue to plague healthcare facili- ties this year, and surgery centers will have to leverage any benefits they have to attract talent away from higher-paying employers. 4. ASCs aligned with local hospitals, or those who strengthened their relationship with hospitals during the pandemic, have a bet- ter chance of thriving in the coming year. As more procedures go outpatient, hospitals that see independent physicians and surgery centers as a vital partner or community asset will have an easier time capitalizing on the transition than in communities where hospi- tals see the ASC as competition. 5. Nimble ASCs with leaders attuned to the current healthcare climate will be better able to take advantage of new opportunities. Di- rect-to-employer contracting is one example of an opportunity that gained steam last year as more large employers sought to cut payers as the middlemen in caring for employees. 6. ASCs in competitive markets are poised to thrive as the federal government tightens scrutiny on anticompetitive mergers. Hospi- tal-employed physicians may also leave their contracts for an opportunity with ASCs if the administration eliminates noncompetes. Losers 7. Surgery centers depending on surgeons who are near the end of their careers will have a tough time as more surgeons opt for early retirement. ASCs with a mix of early-, mid- and late-career surgeon owners have higher valuation potential. 8. Small, independent centers will have a harder time complying with regulatory re- quirements and competing for staff and phy- sicians this year. Many of these centers have been hit hard by increased expenses related to the pandemic while payers continue to squeeze reimbursements. 9. ASCs that added procedures CMS ap- proved for the ASC payable list in 2021, but were removed this year, lost a significant pa- tient base. ese surgery centers will have to pivot strategies to cover the cost of develop- ing those programs. 10. Payers are likely to continue scrutinizing procedures heavily as volume returns and increase prior authorizations. ASCs without a strong revenue cycle team will struggle to get paid on those claims in a timely manner. 11. ASCs in markets where there aren't large, independent physician groups will suffer. Hospitals are acquiring physician groups at a high rate to expand market share and can subsequently keep referrals within the hos- pital network. 12. Surgery centers focused just on the sur- gical aspect of care may find their business model outdated in the near future. Payers and patients are increasingly searching for more convenient care covering the entire ep- isode of care instead of a fragmented expe- rience. ASCs with ancillary services or that are part of a larger organization providing coordinated care will be in a better position to succeed. n The end of ASC-blocking policies may be near By Laura Dyrda L ast year, CMS began requiring hospitals to post prices negotiated with private insurers online and enforced compliance. The agency is also requir- ing insurers and health plans to disclose in-network provider rates by July 1. Both policy changes could be a boon for ASCs. Surgery centers are not required to post negotiated rates online as of yet, but typically they are the low-cost set- ting for surgical services. ASCs stand to win on cost data and often have strong quality metrics as well. As a result, price transparency could also make certificate of need laws obsolete. These laws, which exist in 35 states, were implemented to prevent overutilization and overbilling of healthcare services. The process is rigorous and can block surgeons from opening ASCs, especially if hospitals or other entities oppose them. However, with transparent pricing, contracted rates are out of the shadows. Armed with pay rate and utilization information, potential owners likely are not going to open facilities in areas where they cannot make money. Hospitals likely will not easily give up the influence certifi- cate of need laws afford them, but it will become harder to justify their existence. n

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