Becker's ASC Review

20 THOUGHT LEADERSHIP Why ASCs, health systems, payers need to find middle ground By Paige Haeffele R eimbursement differences between ASCs and HOPDs have been an ongoing challenge for surgery centers, continually making it more difficult for independent ASCs to stay afloat. Becker's connected with Kristopher Kitz, CEO of Eye Associates of Tucson, Wyatt Surgery Center and Tucson Ambulatory Anesthesia, all in Tucson, Ariz., to discuss a strategy for navigating payer-ASC reimbursement issues. Editor's note: Response has been lightly edited for length and clarity. Question: Do you think health systems' increased interest in ASCs will affect the industry? Kristopher Kitz: The more traditional model for an ambulatory center, at least right now, is to form a joint venture with the health system or a Tenet or USPI, or another large organization whereby you sell 51% to them so that they can do the pair contracting for that surgery center. The problem is, I think you're also seeing more and more surgeons who don't want to give up all that control, but still really want to have sustainable payer rates. As health systems start to be put in a position of losing all this volume from their ORs to surgery centers, and wanting to maintain a part of that revenue by owning an ASC as well. Somehow, the three — the health system, the surgeons and the payers — will all have to come together to realize that the only way to make all three happy is a model whereby surgery centers can be appropriately compensated for the work that they do, not at the low-end of the ASC rate and not the high-end of the hospital rate, but somewhere in the middle that works for everyone. Because right now, the model is, if you're not owned by a health system, try negotiating independently with payers and see how that goes for you. That's what I'm doing right now. Luckily, the health system owns a portion, but not by any means the majority, so they can't do payer contracting for us. But we're trying to have the best of both worlds, so I hired the hospital's payer contracting consultant to work for us, to try to get a leg up on this world. I think for the model to succeed, those three interests — surgeons, ASCs and health systems — have to find a way to come together. n How ASCs can ease hospitals' burden By Paige Haeffele A prevalent issue in healthcare for several years has been increased strain on physicians, hospitals and other healthcare workers — and ASCs may be the solution. Becker's connected with Beth LaBouyer, RN, executive director at the California Ambulatory Surgery Association, to discuss multipronged benefits ASCs offer to hospitals. Editor's note: is response has been edited lightly for length and clarity. Question: What are some key ways ASCs can alleviate the burden on hospitals, particularly in terms of patient volume, resource allocation and specialized care delivery? Beth LaBouyer: ere is still a high volume of ASC-eligible cases that are being handled in hospitals unnecessarily — those need to be shied to ASCs. Because ASCs focus on certain surgery types, they can structure scheduling in a way that optimizes time in the operating rooms and reduces turnover time between surgeries. is allows more cases to be done more quickly, which reduces patient wait times and alleviates the burden on hospitals. In particular, there is an important opportunity to address outdated policy limitations in California that restrict cardiology procedures. Already, CMS has approved 23 cardiac catheterization and percutaneous coronary intervention procedures to be payable in the ASC setting — and these are being performed safely in ASCs across the country. In fact, a recent study by ECG of claims data from 2022 and 2023 suggests approximately 10% of CATH and PCI procedures are being performed in the ASC setting. But California law must be updated to allow these procedures to be done in California ASCs. at is important because of three factors: 1. Demand. e demand for cardiac care in the U.S. continues to rise as more patients are screened and treated for cardiovascular disease. 2. Timeliness of care. Research shows that the length of time between initial patient outreach to a cardiologist to the time of a patient's CATH or PCI procedure in California can be as long as five months. 3. Cost savings. e cost of these procedures are 36-47% lower in an ASC when compared to the hospital outpatient department Medicare rate, and it is expected that the cost savings is even greater for commercial payers. As more cases are safely migrated to ASCs, there will be increased opportunities for cost savings and greater access to care. n

• Cover