Becker's ASC Review

16 Becker's ASC 21st Annual Meeting – The Business and Operations of ASCs – Call (800) 417-2035 New York Times Battleground Tracker poll based on interviews of 100,000 registered voters predicted a Senate victory, 51-49, for the Republican Party. The Senate is currently under Democratic control, with Democratic Sena- tors outnumbering Republican Senators 53-45, and two independent sena- tors aligning with the Democrats. The House of Representatives, which is currently under Republican Control, is expected to remain so, especially as the Democratic Party is trailing behind the Republican Party on a number of key engagement indicators, according to a July 2014 survey from the Pew Research Center. According to William Prentice, CEO of the Ambulatory Surgery Center As- sociation, even with the Republican Party's strong positioning for the 2014 midterm elections, the legislative climate isn't likely to change within the next few years, especially because of the Democratic president's power to veto any conservative legislation he feels may undermine his goals for the PPACA — his probable legacy. "What you can see happening over the next two years in any scenario is that they will be like the past couple of years — with not much legislative activity. There will be table-setting for 2016," he said. Even payments to ASCs may not get much of a boost, due to the budget climate, though he expects Congress to revisit the issue of site neutrality: "It will continue to get attention and could be an issue of value to ASCs," said Mr. Prentice. More important than midterm elections are 2016 elections and beyond. After political jockeying has concluded and efforts to get rid of the PPACA die down, Mr. Prentice hopes legislative activity will focus on honing the health- care law and looking for ways to fix some of the obvious problems. "Once the heat dissipates after the election, we could see majorities in both houses circle around good solutions," he concluded. n How Could Midterm Elections Impact ASCs? (continued from cover) M ore ambulatory surgery centers are bringing in higher acuity cases, such as total joint replacements and spinal procedures, but it takes a considerable amount of time and resources to lay the foundation for a successful program. Here are five important thoughts for ASC owners and operators as they consider the transition: Patient safety and selection Patient selection is the most important consideration because these cases have a higher potential for risk. "It is imperative for ASCs to establish a steadfast pa- tient selection criterion that determines which pa- tients can undergo higher acuity procedures in the ASC and which should undergo these procedures in a hospital," says Jessica Nantz, president of Outpa- tient Healthcare Strategies. "For example, patients with comorbidities or a history of significant health issues, such as cardiac problems, are not likely ap- propriate surgical candidates for the ASC." High body mass index and patients with pain medication dependence are also at higher risk for complications and may be better off in the hospi- tal setting, according to Ms. Nantz. She suggests forming a committee with physicians and clini- cians to develop the patient selection criteria. "Make sure you have determined whether there are instances when you would not allow physi- cians to perform these cases in your ASC and ensure your schedulers and the physicians' offices are aware of these rules," says Ms. Nantz. "ASCs must always prioritize patient safety, even if it means less patient volume." Further steps for identifying the right patients and ensuring patient safety include: • Discuss anesthesia levels with physicians and develop appropriate protocols around these anesthesia levels • Develop strict safety protocols, including for infection and risk management • Plan for postoperative care • Develop education for home caregivers and physical therapists Physician recruitment Sometimes physicians already using the center will be able to transition their higher acuity cases to the outpatient setting; other times ASCs may need to recruit new surgeons in the community with the skill and expertise for less invasive proce- dures. The clinical staff is also an important ele- ment to successful cases. "ASCs will want to recruit physicians and/or utilize existing partners who feel comfortable performing the procedures in an outpatient setting, and spe- cifically in the ASC," says Ms. Nantz. "ASCs must ensure the clinical staff has been fully and properly trained to support the physicians performing these procedures. If the numbers are favorable and the ASC moves ahead with the transition, it is worth- while to have the physician performing the higher acuity cases to walk and talk through the procedure multiple times with the clinical staff and address any questions they might have." One of the most common mistakes Ms. Nantz sees ASC leaders make is rushing to do cases once they find a physician willing to perform them. While it's great to have the service available, issues could arise without the proper pieces in place. Protocol development Ms. Nantz advises ASCs not to move ahead with scheduling cases until: • Patient selection criteria is established • Staff are educated • Necessary equipment is acquired • Policies and procedures are developed for preop, postop and emergency care "ASCs would be wise to carefully conduct their due diligence into the new cases," says Ms. Nantz. "Ask the physicians to project their volume and then assume the figure will be at least 30 percent lower. Speak with payers to determine whether they will cover the cost of the cases. Speak with your suppliers and GPOs to determine exactly what supplies will cost. Make sure there's a posi- tive return on investment. If the numbers don't add up favorably for the ASC, these cases could hurt the facility financially." Patient flow Another important consideration is operating room flow. Keep in mind higher acuity cases of- ten take longer than lower acuity cases. "ASCs will want to determine whether it is in the ASC's best interest to tie up an operating room for a longer period of time for a single case or whether that OR can be used more effectively for more lower acuity cases," says Ms. Nantz. "The ASC must project enough volume of these new cases to jus- tify the investment in equipment, training and other preparation costs." The ASC may need to add overnight stays. There are also federal and state regulations to consider Considering New Higher Acuity Cases? Don't Forget the Basics By Laura Dyrda Jessica Nantz

• Cover