As technological advancements create new opportunities in the ASC space, here’s a look at how three specialties are managing a shift to outpatient care:
Cardiology
While cardiology is one of the fastest-growing outpatient specialties, a number of roadblocks could be hampering growth for outpatient cardiology. Infrastructure limitations, regulatory hurdles such as certificate-of-need processes, and payer reluctance are some of the obstacles that cardiologists have identified to Becker’s.
Alignment between Medicare and private payers specifically remains a challenge. Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s last year that the biggest payer issue his ASC is facing is “denials that do not fall in line with the Medicare payable procedures.”
Many private payers aren’t matching Medicare codes for cardiology procedures, Mr. Helmer said, “For example, loop-recorder implants are commonly denied for no prior authorization from private payers, yet, in the Medicare fee schedule, they require no authorization and there’s usually not a problem.”
The presence of private equity has also been met with mixed opinions by physicians in the growing outpatient cardiology space. Of the 342 cardiology clinics that have been acquired in the past decade, more than 94% of acquisitions occurred during 2021 to 2023, according to a recent Medscape report. While private equity has a more established presence in other fields, such as orthopedics and ophthalmology, the newness of private equity’s presence in the field sparked discourse among cardiology experts.
“Private equity is neither inherently good nor bad,” said Jerry Blackwell, MD, president and chief medical officer of MedAxiom, in the report. He added that there is “tremendous heterogeneity” in private equity ownership contracts, and the fragmented nature of cardiology make it an ideal space for such investors.
“Private equity in the hospital space is nothing like private equity in the practice space,” he added. “Most of the horror stories you’re going to hear are in the hospital space. There are some horror stories in the practice space, but they’ve got nothing to do with cardiology.”
Anesthesia
As less-invasive procedures become more common and the U.S. population ages, the anesthesia industry grapples with a number of challenges to meet the demand for outpatient surgery.
Staffing continues to be a central concern for anesthesia providers and ASC leaders. Tina Driggers, administrator of Winter Haven, Fla.-based DISC Day Surgery Center, called for a long-term solution focused on increasing the number of anesthesia providers.
“We will need to increase our MD/CRNA/AA graduates and training facilities,” she said. “In the meantime, we will need to address remuneration with commercial insurance carriers about the volume of care, higher acuity of the patients, patient outcomes and satisfaction.”
With declining reimbursement rates also being a central concern for anesthesia providers, Scott Mayer, CEO of Rosemont, Ill.-based Ambulatory Anesthesia Care, told Becker’s that ASCs and other outpatient facilities must hone in on their anesthesia billing processes, particularly for Medicare patients.
“One of the things we’re trying to educate the space on is, when you do want to bring the Medicare population in — which we’re happy to service, support and take care of — Are you taking into account that there may need to be some financial stipend or support given to the anesthesia side for that specific patient?” he said.
This differs from the way that many ASCs may be approaching their current anesthesia payment processes as it relates to Medicare patients, specifically, by separating that calculation from a practice’s overall anesthesia billing.
“I feel like people are lumping these bigger, kind of macro situations of, ‘Oh, we need to pay [for] anesthesia …’ when, really, we’re not looking at the root of the problem, which is Medicare reimbursement driven on the anesthesia side, and that utilization needs to be increased as well,” he continued.
Spine
Outpatient spine procedures grew among Medicare patients between 2010 and 2021, with significant yearly growth at ASCs. The findings, published in the March 2024 issue of the North American Spine Society Journal, found the total number of outpatient spine procedures rose about 193% over 2010 to 2021. The compound annual growth rate for outpatient cases per year was 9.9% for hospital outpatient departments and 15.7% for ASCs.
Spine surgeons are also eyeing increasingly high-acuity procedures for the outpatient setting as enhancements to surgical technologies make it safer and more feasible to complete complex procedures in ASCs. However, this is likely to be a gradual process, Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, told Becker’s.
“More ASCs will need to get special exemptions to hold patients greater than 23 hours,” Dr. Gantwerker said. “Some ASCs should stick to the simple, safer and better margin surgeries. For those wanting to push the envelope, I recommend doing a careful safety analysis with a multidisciplinary team of anesthesiologists, pain physicians, internal medicine, nursing and surgery staff to decide what is safe and feasible. Just because you can do a surgery in an ASC setting does not mean you should. Any transformation into a higher acuity center should take place gradually, with very careful consideration of each patient case and its appropriateness for the ASC setting,” he added.
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