Issue link: https://beckershealthcare.uberflip.com/i/170040
Coding, Billing & Collections 37 ACOs 101 for ASC Administrators: Q&A With Stephen Rothenberg of Numerof & Associates Stephen Rothenberg By Laura Miller A ccountable care organizations are beginning to sprout up across the healthcare landscape in many communities, led by physicians, hospital and health system leaders. Many ambulatory surgery center administrators wonder where their ASCs will fit in. "It's worthwhile for any ASC leader to have a general understanding of what the goals of the accountable care organization are," says Stephen Rothenberg, JD, a consultant with Numerof & Associates, Inc. "In general, they are trying to lower the overall cost of care for the population they serve without sacrificing quality. Understanding their infrastructure matters, too. For example, if they are a CMS ACO, they have requirements for infrastructure and quality metrics. In today's market, understanding a bit about the fundamentals of ACOs is important." Mr. Rothenberg discusses how ACOs could impact ambulatory surgery centers, and offers smart strategies for ASC leaders going forward. could be an opportunity, then, since the ACO is less likely to view an ophthalmology ASC as a competitor. If hospitals don't have a specialty in-house already, they are more likely to sit down with you and discuss how you can partner. Q: What factors should ASC leaders consider before participating in the ACO? Could it have any negative consequences? SR: They need to find out what kind of ACO is in their market (a CMS ACO or a private ACO). They will need to understand what quality and cost commitments the ACO has made before exploring partnerships. Q: How are ACOs changing the marketplace? Stephen Rothenberg: That's a big question. In some areas, ACOs are driving the market consolidation we're seeing today. In addition, there's been some consolidation across specialty physicians and group practices. They can change the landscape in a given marketplace, and ASCs will have to figure out how to best compete in a market that includes one or more ACOs. Q: When should ASCs consider becoming involved in ACOs? SR: ASCs facing an ACO that has a dominant position in the market will have to figure out how they can work with them. A lot depends on the extent to which the hospital considers the ASC a competitor or a potential partner. That in turn depends on the ACO's access to alternative sources of that practice specialty, and of course, the level of demand in the market area. For example, some ACOs may have an economic interest in directing patients to certain providers even if they don't necessarily provide the lowest cost or best outcome – if there's a competitive mindset the risk is losing referrals and being shut out of the population. Some specialty areas, such as ophthalmology, may find it easier. ACOs, in large part, aren't seeing ophthalmology as a priority right now and don't want to spend their surgical room time on those procedures. There ACO put you at risk of losing market share? Conversely, what can you bring to the ACO? In many cases, the value proposition of the ASC is that it can be cost-effective and can demonstrate good clinical outcomes. They will also need understand how the ACO and the ASC could be beneficial partners. Will partnering with the ACO ensure more referrals to your ASC? Will not partnering with the ▪ ▪ ▪ gregz@kbic.com andreav@kbic.com • • •