Ambulatory Surgery Centers: Trends to Consider
Despite a heavy regulatory burden under Medicaid reimbursement rules, Ambulatory Surgery Centers have continued to compete strongly for outpatient procedures in the last three years. Regulatory costs continue to be offset by excellent efficiency metrics driven by well-scheduled OR usage, focused offerings, and effective use of technology.
Recent regulation has not favored ASCs. Medicare reimbursement rates to ASCs have dropped steadily compared to Hospital Outpatient Departments. At the same time, demand for outpatient services has grown steadily. Improved technology has enabled more procedures to be performed without the need for inpatient services. Further demand has been driven towards outpatient centers by increasing cost pressure.
With the ASC Quality and Accessibility Act of 2017, Ambulatory Surgery Centers can hope to see an increase in top-line revenue not just through volume, but improved reimbursement rates. The measure aims to base reimbursement rates for ASCs not on the Consumer Price Index (CPI), but the more appropriate Hospital Market Basket, which measures the increase in cost of providing healthcare services.
Even though regulation may improve the standing of ASCs, it is important to remember that more regulation means more red tape stands between billing and the reception of funds. Consequently, surgery centers need to continue to focus on one of their greatest strengths: efficiency. Reimbursement rates and payment methods will need to be monitored and managed carefully.
Negotiations with payers are paramount to securing revenue streams going forward. If processes for managing counterparties are not yet in place, ASCs must ensure that this capability is established as soon as possible.
Both patients and suppliers are increasingly demanding one-stop solutions – including for their healthcare needs. As specialists for outpatient care, ASCs are in a position to capitalize by diversifying their offering from single-solution models, such as pure ophthalmology, to a multi-solution offering that includes other specialties that do not require patient stays like gynecology or orthopedics.
In addition, value-added services such as imaging capability, physical therapy, or mental health care, can greatly enhance patient retention and allows surgery centers to capture a greater percentage of health expenditures – in particular with growing acceptance and coverage for preventative medicine.