54
13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine – Call (800) 417-2035
the report "Bundled Payment Models: Bottom-
Line Strategies for Insurers," which includes
case studies of Horizon Healthcare Services and
Arkansas Blue Cross and Blue Shield. In May,
Bedford (N.H.) Ambulatory Surgical Center and
Harvard-Pilgrim embarked on a bundled pay-
ments pilot program focused on colonoscopy.
In another study, bundled payments were found
to reduce the total cost of care for patients with
three different types of cancer by $33 million.
Bundled payments, like many healthcare strate-
gies still in their infancy, are yielding mixed re-
sults, but remain at the forefront of new pursuits.
8. Pay equalization debate. ASC payment as
a percentage of hospital outpatient department
payment has been on the decline for years, but
the debate over the difference remains heated. In
January, the Medicare Payment Advisory Com-
mission recommended a 3.25 percent increase in
pay for HOPDs, while recommending that ASC
payment remain flat.
A common point of contention in the argument
over ASC and HOPD reimbursement is site neu-
tral payments, or the equalization of rates. The
OIG recommended that HOPD rates be lowered
to ASC rates, and MedPAC recommended the
same for a select number of procedures. CMS op-
poses rate equalization and it is unlikely to actu-
ally go into effect.
For 2015, CMS proposed to increase ASC pay-
ment by 1.2 percent and HOPD payment by 2.1
percent.
9. Shift to outpatient utilization. In 2015, 19
percent of total private health insurance spend-
ing is expected to go towards outpatient services,
according to a PwC's Health Research Institute
report. Case volume is steadily shifting from the
inpatient setting to the outpatient setting, driven
by desire to lower healthcare costs and enabled
by increasingly sophisticated technology. Hospi-
tals are experiencing this shift — 36.2 percent of
hospital respondents to a Kaufman Hall survey
reported a 3 percent or more increase in outpa-
tient utilization — and as a natural consequence
are turning their eye towards ASCs.
In 2013, Crozer-Keystone Health System acquired
the Surgery Center of Pennsylvania in Haverford.
Over the past several quarters, the health system
reported operating losses, but after the ASC ac-
quisition the system experienced a 19 percent
increase in surgical volume. Many hospitals are
following suit and building or acquiring their
own ASCs to take advantage of the low-cost, high-
quality environment.
10. The death of Joan Rivers. On August 28,
comedienne Joan Rivers underwent an endoscopic
procedure at New York ASC Yorkville Endoscopy.
Ms. Rivers went into cardiac arrest, was transferred
to Mount Sinai Hospital in New York and died
Sept. 4. The events that followed thrust the entire
field of outpatient surgery into the public eye.
As the media coverage unfolded, it came to light
that Ms. Rivers' ENT physician, present in the op-
erating room during the procedure, was not only
without privilege at the ASC, but also allegedly
took an unauthorized photogrpah with the anes-
thetized patient. Further still, Ms. Rivers' ENT
physicians allegedly took an unplanned biopsy of
the performers vocal cords.
The New York State Department of Health is in-
vestigating whether or not the ASC's team is re-
sponsible for Ms. Rivers' death. In the meantime,
Ms. Rivers' daughter Melissa Rivers has indicated
she intends to file a lawsuit against the ASC, ac-
cording to a WHDH report. Regardless of the in-
vestigation's or lawsuit's outcome, the high profile
nature of the story caused the public to question
the safety of outpatient surgery. n
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