The healthcare industry continues to experience significant shifts in the way it delivers and pays for care. Ambulatory surgery centers (ASCs) are an increasingly popular alternative to traditional hospital settings for many medically appropriate cases. As a result, payors are looking at how ASCs can reduce expenses and improve patient and provider experiences.

 Atlas Healthcare Partners’ Chief Revenue Optimization Officer Heather Richards discusses key payor trends impacting ASCs and what they mean for patients, providers, and payors alike.

What forces are directly impacting the shift in medically appropriate cases to ASCs?

With the rise of healthcare consumerism, the primary forces driving the shift to ASCs are cost effectiveness, ease of access, and the consumerization of healthcare. The substantial financial burden associated with surgical procedures in inpatient or outpatient hospital settings is no longer sustainable. ASCs generally offer greater affordability compared to hospitals, and this has become a major consideration for all parties.

ASCs can perform many procedures at a fraction of the price of hospital-based care due to lower operating expenses. Such savings are increasingly important since healthcare expenditures continue to rise. The Society for Human Resource Management stated that health care benefits prices are expected to return to pre-pandemic levels and to continue outpacing overall inflation – with a projected median increase of 7.5 percent for medical plan fees.

In addition, patients often prefer the convenience of ASCs, rather than having to travel to a hospital many miles away. ASCs offer shorter wait times, easier scheduling, and more personalized care. Consumers want to have a voice and a choice in the care they receive, and ASCs provide consumers with affordable, convenient, expert care closer to home. This shift will continue as more payors and providers recognize the benefits of ASCs over traditional hospital-based care. Healthcare in the U.S. requires more economically efficient and convenient care options if the industry is to evolve.

How will employer (self)-driven plans and savvy healthcare consumers drive change for healthcare payors? How do payors stay relevant and add value in a direct-to-employer market?

Value-based care (VBC) has been a topic of discussion for several years and is now moving forward at a measurable pace in part due to savvy healthcare consumers–they are a major force driving change. Consumers are becoming more involved in their healthcare decisions, creating a demand for more transparent and personalized healthcare options, including settings with competitive pricing such as ASCs.

As the healthcare industry continues towards VBC, payors are finding it challenging to operationalize their system and infrastructure. For example, insurance companies are accustomed to processing fee-for-service plans, and introducing bundled payments can be challenging. In this direct-to-employer market, payors need to adapt and find ways to stay relevant, add value, and help make it easier for patients and providers to utilize more effective and efficient sites of care. Payors should recognize how ASCs can offer safe care and reduce administrative burdens, making it easier for providers and their patients to receive care.

What is the impact of payor changes on patient access, and how can ASCs work to minimize the effects on patients?

ASCs can work to minimize these effects by working with payors to negotiate contracts that provide the best value for patients. Additionally, partnering with providers and health systems offers more comprehensive care and a broader range of ASC services, which can help reduce expenses and improve outcomes.

Our partnership with Banner Health and Corewell Health allow us to drastically increase patient access to high-quality, affordable, and convenient care through joint venture ASCs. Through our partnership, Banner expanded to 27 ASCs, increasing access to high-quality healthcare in the Arizona region with critical expansion of service offerings which allow patients to receive efficient and value-driven expert care, closer to home.

ASCs also are more efficient and are better suited for certain outpatient procedures, such as certain orthopedic and GI, and ENT procedures. While patients with severe medical cases belong in a hospital setting, there are many instances where patients can receive outpatient care at an ASC, and it will benefit hospitals and patients.

Think of it this way: hospitals have different lanes of traffic, including an acute lane for serious cases, an elective surgery lane for non-emergent cases, and a rapid-fire lane for unpredictable cases. When these lanes merge, it can cause disruptions and affect physician schedules, as hospitals only have so many resources and they should be spent on emergency and acute care, while elective surgeries can be migrated to ASCs.

ASCs bring efficiency and accessibility to patients, along with greater provider satisfaction. They specialize in certain procedures, and therefore have become experts on delivering them with quality at lower cost.

What is your strategy to adapt to payer changes?

The shift towards ASCs and other financially sustainable alternatives shows that healthcare is finally starting to catch up to our free-market world. Patients will have access to high-quality care at a more affordable price, payors can reduce their healthcare spending, and providers will offer a wider range of services while receiving competitive compensation.

Segregating emergent and non-emergent surgeries can help improve patient care and physician efficiency. Payors need to create neutrality and reward hospitals for moving medically appropriate cases to ASC settings. This will help improve quality of care as well as efficiency.

Atlas Healthcare Partners wants to help make this a reality and make ASCs an integral part of the healthcare system. This involves developing partnerships with payers and other providers, diversifying revenue streams, and investing in new technology and equipment to stay ahead of the curve. It also involves implementing new care models, such as bundled payments, that incentivize efficiency and quality.

Interested in learning more about ASCs payor trends? Contact Heather here.