Becker's ASC Review

9 THOUGHT LEADERSHIP Why ASCs are expected to see 'continued growth' in 2023 By Riz Hatton Several healthcare leaders see a bright future for ASCs and expect the market to grow in 2023. ree healthcare leaders connected with Becker's to answer, "What does 2023 have in store for the ASC industry?" Editor's note: Responses have been lightly edited for length and clarity. Braden Batkoff, MD. Chief Medical Officer at United Cardiology Partners: • Continued ASC growth as more care moves to the lower cost, more patient friendly ASC environment. • Expansion to the ASC of historically hospital-based procedures, particularly cardiology, as CMS has approved payment for many cardiology procedures in the ASC setting and as providers become more comfortable performing these procedures outside of the hospital setting given the accumulation of safety data supporting this migration. • Anticipate further health system partnerships with physicians and investor-backed companies to satisfy the anticipated demand in this area. Neil Mangus. Senior Director of Business Development of ASCs at Orlando (Fla.) Health: I believe we'll see continued growth of ASCs; in numbers, size and specialties, following CMS' payment rate increases and additions to covered procedures to include more cardiovascular and now interventional radiology. Much of the growth will likely be driven by health systems looking to free up their hospital operating rooms for more acute cases. We're seeing more and more multiple-site acquisitions as well as the development of larger ASCs with 10 or more operating rooms — either multispecialty or your more traditional orthopedic, neurosurgery and spine. Mike Piver. Executive Director of Ambulatory Services at Infirmary Health (Mobile, Ala.): 2023 will offer ASCs an opportunity for continued growth as more and more procedures migrate into the outpatient surgical arena. is growth will be driven by payers, patients and self- insured employers looking for less expensive alternatives for outpatient surgery versus a hospital setting. Growth will also be driven by continued technological advancements in the minimally invasive surgical instrumentation area, hospitals looking for creative ways to partner with surgeons through joint venture agreements in ASCs, and improved anesthesia techniques geared to early ambulation while controlling pain. However, this growth may be hindered by the availability of ASCs to find anesthesia coverage along with the continued increase in salaries, wages, benefits and supply costs. n 'Shoot to where the puck is going': Hospital CEO looks to ASCs to drive margins By Patsy Newitt H ospitals and health systems faced formidable margin declines in 2022 amid labor shortages, skyrocketing operating costs and declining inpatient volumes. Many hospitals are looking to ASCs and outpatient surgery to offset these losses and boost revenue, particularly as surgery is increasingly migrating to the ASC setting. Mike Slubowski, president and CEO of Livonia, Mich.-based Trinity Health, which comprises 88 hospitals across 26 states, told Becker's that ASCs are a huge growth opportunity for Trinity Health. "You have to shoot to where the puck is going, and ambulatory surgery is rapidly moving to freestanding ASCs, so we have partnerships with a number of physician groups to do freestanding ambulatory surgery," he said. "We're starting to open a lot more freestanding ASCs. Care is shifting away from hospital-based ambulatory surgery as well because patients and payers don't want to cover the additional cost of being hospital-based." Following the puck for Mr. Slubowski means following the "proliferation" of ASCs being developed by investors or physician-owned groups and health systems. The ASC industry is historically physician-owned. Fifty-two percent of Medicare-certified ASCs in the U.S. are 100 percent physician-owned, according to the most recent data from Advancing Surgical Care. Twenty-one percent of ASCs are jointly owned by physicians and hospitals, while 15 percent are jointly owned by physicians and corporations. The shift of what used to be short inpatient stays to ambulatory settings is also changing the way inpatient care is provided, Mr. Slubowksi added. "There will always be a place for hospitals and inpatient care. I think complex care patients with multiple comorbidities and chronic conditions are still going to require inpatient care," he said. "... But I think it is shifting much more towards intensive care and general medical care for complex patients." He is concerned, however, about the oversaturation of ASCs in some markets. Other leaders agree. "Over the course of the last five years we have seen massive shifts in cases from the hospital setting to the ASC," Andrew Lovewell, administrator of the Surgical Center at Columbia (Mo.) Orthopaedic Group, told Becker's in July. ''This has created competition amongst ASCs, as well as ASCs and hospitals in key markets. The key levers that have created such full scale shifts outside of COVID-19 are related to the Medicare inpatient-only list becoming more relaxed under the previous administration as well as the evolution of safe care in the outpatient setting." n

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