Eight leaders joined Becker’s to discuss the biggest disruptors of the ASC industry.
Question: In your view, what’s the most significant disruptor shaking up the ASC industry today, and how is it impacting your center?
Shakeel Ahmed, MD, CEO of St. Louis-based ASC group Atlas Surgical Group. There are multiple headwinds facing us. Anesthesia shortage, hospital adversity, draconian CON laws. The list goes on. But in my opinion, the single biggest disruptor in the ASC industry is the inability to maintain positive cash flow — despite rising costs of goods, increasing employee salaries, persistent pressure to lower facility fees and the continued inaction by CMS to adjust reimbursement rates in line with inflation. Our ASC franchise is taking this in stride being more business savvy with marketing, supply management and smart staffing are the cornerstones of our care. Steps we take with the thought in mind that nothing should disrupt good patient care and experience.
Heather Cobb, RN. Administrator of Momentum Specialty Surgery (Wichita Falls, Texas): We are the only surgery center in our area that provides multispecialty services to roughly 16 counties. With ASCs continuing to grow and offer more affordable healthcare needs, their focus is mainly on surgical needs. With that in mind the cost of medical supplies increasing, and decreased reimbursement rates continues to place a burden on ASCs bottom line. The second biggest disruptor is staff. As I mentioned, we are a smaller center, and it is hard to compete with local hospitals in the area that pay a premium hourly rate, with sign-on bonuses.
Les Jebson. Regional Administrator at Prisma Health (Greenville, S.C.): The potential for unforeseen supply chain disruptions whether it is from production constraints, geopolitical changes or vendor product recalls.
Ira Kornbluth, MD. President of Clearway Pain Solutions. I think there are two significant “disruptors” shaking up the ASC industry. The first is alignment with physicians via ASC ownership. With ownership, physicians take greater pride in the overall center performance and pay more attention to processes, efficiencies and outcomes. We have observed more physician engagement when they have ASC equity. The second significant “disruptor” pertains to the adoption of new technologies to improve scheduling, authorization and operational efficiencies. AI will likely have a greater impact moving forward.
Sean Gipson. Division CEO and President of Remedy Surgery Center (Hurst, Texas): One of the most significant disruptors in the ASC industry today is the increasing adoption of value-based care models and consumer-driven healthcare. With a growing shift toward value-based care, healthcare providers and organizations are being incentivized to focus more on patient outcomes rather than the volume of services provided. This is pushing ASCs to adapt and innovate in several ways.
One is with cost efficiency and transparency. Patients are becoming more cost-conscious and seeking out options that provide better value. Most ASCs are more cost-effective than hospitals for certain procedures. However, to remain competitive, the ASC must maintain transparent pricing, improve operational efficiency, and ensure high-quality care. ASCs that can demonstrate these qualities are better positioned to attract patients.
Another innovative incentive is with bundled payments and contracts. A bundled payment model is becoming more common, ASCs must adapt to provide care within a fixed cost structure. This has led to a focus on operational efficiencies, streamlining care pathways and improving patient outcomes to remain profitable under these models.
The rise of telemedicine and remote monitoring is also reshaping the industry. ASCs are adopting telehealth services for pre- and postoperative care, enhancing patient engagement, and improving follow-up care. Moreover, surgical robotics and AI-driven diagnostics are pushing the envelope in terms of precision and patient outcomes, and ASCs that adopt these technologies can position themselves as leaders in high-quality, cutting-edge care.
Additionally, as patients are becoming more informed and actively engaged in their healthcare decisions, they expect higher levels of service, from things like ease of scheduling to personalized care. ASCs are having to improve their patient experience, with better digital interfaces, more personalized care and clear communication before, during, and after the surgery.
Lastly, policy changes and evolving reimbursement models are also disruptive forces. ASCs are navigating complex regulatory environments, with Medicare and private payers increasingly scrutinizing billing practices, quality of care, and patient satisfaction. For ASCs, staying competitive and thriving amid these disruptions means balancing cost control, maintaining high-quality care, and embracing technology and patient-centered models.
Pradnya Mitroo, MD. President of Fresno (Calif.) Digestive Health. The most significant disruptor shaking up the ASC industry is the burden of prior authorizations and denials. Although insurance companies want procedures moved to the ASC because it’s cheaper than the hospital they are putting a large burden on us to do prior authorizations for procedures which is very time consuming. Between checking eligibility and then getting the PA, our staff is spending a significant amount of time doing this. This adds additional staffing expenses, and reimbursement rates are not keeping up with these rising costs.
Joe Peluso. Administrator at Aestique Surgery Center (Greensburg, Pa.) Site neutral payments. In 2005, 59% of outpatient surgeries were performed in hospital outpatient departments. By 2020, that number was reversed, with only 40% of outpatient surgeries performed in HOPDs. Research demonstrates that patients who receive care in ASCs are less likely to seek emergency room or hospital inpatient care after a procedure, and the ASC infection rate is half that of hospitals.
Medical and technological advances have enabled a growing range of multispecialty surgical procedures to be performed safely in an ASC setting. As medical innovation continues to advance more and more procedures will transition to and be able to be performed safely in the ASC setting. Faster acting and more effective anesthetics and less invasive surgical techniques, such as arthroscopy, have driven this migration. Procedures that only a few years ago required major incisions, long-acting anesthetics and extended convalescence can now be performed through closed techniques utilizing short-acting anesthetics, with minimal recovery time. ASCs provide cost effective care that saves the government, third party payers and patients money. Accordingly, CMS and insurers on average pay significantly less (approximately 60%) when compared to rates paid to hospital HOPDs for the same procedures. Patients’ responsibility for co-pays and coinsurance are also significantly lower when care is provided in an ASC. Both employers and insurers continue to explore ways to support the movement of patients and procedures to the ASC setting. However, the continued growth in the number of patients treated in ASCs resulting in major cost savings is being exploited by the widening disparity in reimbursement that hospital HOPDs receive (Medicare up to 72% higher) for the same procedure. In addition, Medicare (CMS) applies different standards limiting the scope of surgical procedures and reimbursement in ASCs, even though HOPDs are clinically identical.
Site neutral payment reform is necessary to equalize reimbursements for the same services regardless of whether they are provided in a HOPD or ASC. The reimbursement methodology needs to consider an aligned unified blend of OPPS HOPD and ASC payments that will lead to lower healthcare costs for the payers and patients and better access to care.
John Webb. President of MMC Capital Markets and Co-Founder of Ker Medical. LIke with any business, what I see lacking in the ASC world is very little effort towards new business development. Most ASCs do not operate at the max and most only utilize their surgical space at 50-60%. So we focus on recruiting additional providers and are in direct competition with hospitals. We can offer different opportunities that hospitals can not offer.
Sally Wright. CFO of Meridian Surgery Center (Puyallup, Wash): The disparaging contracting between independent and hospital systems for same cases and the inability to make any ground with payers
The post The biggest disruptor of the ASC industry appeared first on Becker’s ASC.
