Hospitals and healthcare leaders face numerous challenges, including providing high-quality care while managing costs. Ambulatory surgery centers (ASCs) offer a strategic solution for healthcare organizations seeking to enhance patient care, access, and financial sustainability.
Atlas Healthcare Partners’ VP of Cardiovascular Operations Kristen Richards highlights the advantages of cardiovascular (CV) ASCs, discussing their role in transforming healthcare delivery and ensuring accessible, cost-effective, and high-quality care.
How do you approach hospital leaders who may be concerned about leakage of inpatient CV procedures?
Leakage is a pressing concern for hospitals as it directly impacts volumes and revenue. Hospitals often operate at or near-maximum capacity, leading to lengthy wait times and scheduling challenges.
Developing an effective ASC strategy within the health system provides an opportunity for hospitals to capture and retain patient volumes by offering specialized CV procedures in a lower-cost setting with easier access, as well as easing scheduling issues. It’s about ensuring patients receive the right care, at the right location in order to achieve improved outcomes and cost-effectiveness, and enhance patient satisfaction so they can retain patients long term.
How important is fostering physician relationships in the success of implementing ASC strategies?
Effective collaboration with physicians is key to the success of any healthcare strategy. According to Harvard Business Review, misalignment between physicians and health systems is among the fundamental issues ailing U.S. health care. ASCs provide a unique opportunity to align hospital administration and physicians, fostering collaboration, ownership, autonomy, and efficiency
Joint venture partnerships offer a plethora of benefits to physicians, as they enable physicians to tap into the hospital’s leverage. This leverage can prove invaluable when seeking access to insurance plans or negotiating improved reimbursement rates that may otherwise be challenging to attain independently.
Open communication and shared goals are vital in implementing joint venture partnerships, so physicians and health systems have a vested interest in the ASC’s performance and outcomes. Involving physicians in decision-making and offering them part ownership strengthens relationships, retains talented physicians and enhances patient care. By sharing ownership, hospitals and physicians achieve success together.
How can ASCs contribute to lowering costs while maintaining quality in today’s cost-conscious healthcare environment?
Shifting procedures to a lower-cost setting helps mitigate the financial burden associated with expensive inpatient stays. This cost reduction is achieved through streamlined processes, efficient resource utilization, and optimized care delivery. Our partners Banner Health and MedAxiom recognize the benefits of this approach. Over a four-year period, Atlas helped Banner more than triple its ASC network from 8 to 27 ASCs, which has significantly increased its market share and expanded ASC service line offerings.
What are some recent advancements in CV ASC procedures that have improved patient outcomes and recovery times?
The future for CV ASCs looks promising as payors continue to look to approve more procedures that can be safely performed in ASCs, such as AFib ablations, Watchman device implantation, and structural heart interventions. These developments further solidify the role of CV ASCs as a vital component of modern CV care.
How do CV ASCs align with the broader efforts to address rising healthcare costs and improve overall healthcare affordability?
Last year, Medicare launched an outpatient procedure price comparison tool highlighting member out-of-pocket differentials between ASC and hospital-based outpatient department (HOPD) settings. It shows, for example, that a common left heart caths (CPT 93458) total cost in the ASC is $1,735 with a patient responsibility of $346, versus the same heart cath in a hospital with a total cost of $3,259 and a patient responsibility of $923.
Unfortunately, CMS continues to cut reimbursement to physicians and cardiology has been greatly impacted. However, CMS did increase reimbursement 2.8 percent for the ASCs. Reimbursement in the CV ASC setting is significantly less than in hospitals. On average, CMS reimburses ASCs at 53 percent of the rate it reimburses HOPDs for the same procedure, according to a 2018 report from an ASC management company. This makes ASCs attractive to payers, as well as patients who see reduced co-pays.
Technology advancements have significantly improved in the acute care setting which has driven the shift from inpatient to HOPD to ASC Setting. It’s been a progression through the years of better meds, better stents, better devices, and better diagnostic and therapy options that have improved outcomes and decreased length of stay.
How do CV ASCs contribute to the overall shift towards value-based care and population health management?
CV ASCs contribute to improving healthcare affordability and achieving better outcomes on a larger scale. This approach aligns with the broader goals of value-based care, which incentivize healthcare organizations to prioritize quality, efficiency, and patient satisfaction.
Are there unique considerations or factors to keep in mind when it comes to quality assurance and patient safety in CV ASCs compared to hospital-based care?
To ensure optimal quality and safety, CV ASCs must implement rigorous processes to measure and manage performance effectively. Tools are available to capture data and report quality and safety performance, enabling care optimization. It is crucial for CV ASCs to establish specific quality benchmarks and continuously monitor outcomes to ensure consistency and adherence to best practices, as quality metrics have yet to be established in the CV ASC setting. While there are societies that are actively working on developing a tool to implement quality benchmarks for CV ASCs across the U.S., it will take time before they can be implemented. Centers should absolutely identify 1-2 quality measures to ensure they are optimizing care delivery in their CV ASC.
Any final thoughts?
The American Heart Association estimates that nearly half of the US population will have some form of CV disease, with costs projected to reach $1.1 trillion by 2035. By providing cost-effective, high-quality CV care, ASCs contribute to overall efforts to address rising healthcare costs and improve healthcare affordability. Through ASC partnerships, healthcare organizations can expand their service offerings, improve patient outcomes, and achieve greater cost-effectiveness.
To learn more about the benefits of CV ASCs and how you can implement an effective ASC strategy within your organization, contact Kristen here.