Low Cost, High Quality ASCs and Offices are the “Best Fit” Future for Millions of Americans.
As recently as 10 years ago, the growth and adoption of ambulatory surgery centers and surgical offices was a revolutionary idea. Despite a 60 year history in the US, the idea of lower cost, high quality outpatient surgery in non-hospital sites of service was somewhere between invisible or outright taboo, particularly with payers. Having a conversation with an insurance executive could have them fully on board with an ambulatory surgery model that benefits clinicians, patients and payers and fully aligns with the goals and policies of value-based care, and they could say, “This is great but how do you get someone to be the first patient?” Not realizing that ASCs and offices already account for millions of patients a year.
Non-Hospital Surgery is the Future of Healthcare
However, like so many facets of healthcare, the pandemic pressure-tested healthcare in the US and found out that, in many cases that hospitals, for all of their excellence and expertise, represented a bottleneck in access to care, particularly for elective and outpatient surgical procedures for patients who did not require the full freight of a hospital. With that lesson learned, physician groups, health systems, and investors like Amazon and Apple have adopted alternate sites of service to deliver safe, effective surgical care. The explosion of ASCs in particular is undeniable – a web search any day of the week will return a press release of another ASC breaking ground. Each year, CMS authorizes additional procedures for these non-hospital settings for federal populations. Finally, innovations in surgical techniques and fine-tuned anesthesia continue to improve outcomes and recovery times that were already at or beating hospitals.
The Best Site of Service for Every Patient
Fundamentally, most of healthcare is realizing that there is a right-sized site of service for every patient and procedure, opening up low cost, high quality outpatient surgery as an evolution of safe, accessible, effective healthcare in the United States. It comes down to understanding that having enough options via hospitals, ASCs, and offices will make it happen. In doing so, patient out of pocket cost and payer expense drops through a reduction (if not elimination) of facility fees, doctors and nurses have more options to deliver care in non-hospital environments that allow them schedules that are simultaneously more reliable and flexible, and patients can have quicker access to that care.
In a more specific sense, barring direct concern by the patient’s doctor, the vast majority of colonoscopy screenings can (and should) be done in ASCs or offices. Johns Hopkins Bloomberg School of Public Health found that hospital facility fees were 55% higher in hospitals than ASCs. Furthermore, while ASCs have facility fees significantly lower than hospitals because of their focus and efficiency, office surgical sites will not have any facility fee at all, meaning that 55% is a starting point for savings passed on to patients and payers. Despite this, payers are still dragging their feet on engaging with ambulatory-specialty groups (particularly anesthesia). There’s some complexity to acknowledge there, though: smaller, more agile payers like Sidecar Health isn’t just embracing “best fit” sites of service for patients, they’re actively joining us in calling for greater attention to be paid to the opportunity. They published their own data covering five common outpatient procedures, publicly sharing the out of pocket cost for their own covered lives, finding even greater savings than the JHU report. This doesn’t even account for reduced time in procedure, PACU, under anesthetic, and by extension, patient satisfaction and facility throughput.
What’s Stopping Progress?
Surgeons understand. More agile payers understand. Even hospitals are getting on board and building their own ASCs. The Scope is, fundamentally, about a celebration of solutions that bring the best care to the most people, particularly in ambulatory surgery and anesthesia, so rather than a scold, we’ll end on a call to action:
The platonic ideal of business and innovation, even the business of healthcare, is to disrupt old methods that aren’t serving our mutual best interests, and replace them with something better. There is no doubt that non-hospital sites of service are better. They’re faster, more cost effective, and the quality and safety records speak for themselves.
What large payers will be the first to claim their seat at the table and embrace the next evolutionary leap of healthcare?
Who is ready to discuss equitable reimbursements that allow outpatient surgical sites and their anesthesia partners to thrive, while simultaneously helping payers and patients reduce their costs?
Anesthesia and Value-Based Care: From surviving to thriving.
Portions of this piece on anesthesia and value-based care were originally published by Scope partner practice Mobile Anesthesiologists in Becker’s ASC review. It has been updated to reflect policy changes by CMS and changing landscape of non-hospital surgical care. While the backbone of value-based care is primary care and preventative medicine, inevitably surgical intervention is...
Scope Practice Spotlight: Mobile Anesthesiologists
The Competitive Advantage: The Mobile Way From the perspective of Chicago’s Mobile Anesthesiologists, the accelerating tailwinds of payers, patients, value-based care, and COVID-19 have had a positive impact on the physician office space over the past two years. In this post-COVID world, we will continue to see patients look for alternatives to hospitals and ASCs...
Data Series Part 3: Healthcare KPI Pitfalls and Measuring Useful Results
Once you have established key performance indicators (KPIs) that are measurable, influenceable, and have found that they align with a practice’s overall goals, the work really begins. After all, what good is data if you’re not going to use it? In order to determine how to actually use these healthcare KPIs that you have established,...