Healthcare Reform: Where Do ASCs & Group Practices Stand?

At the Becker's Hospital Review 5th Annual CEO Strategy Roundtable on Nov.14, industry experts discussed how healthcare reform impacts ambulatory surgery centers and group practices.


1048Greg Koonsman, Senior Partner of VMG Health, and Wesley Curry, MD, CEO of CEP America honed in on how healthcare reform will affect ASCs and group practices in the session moderated by Amber McGraw Woods, a partner of the Chicago law firm McGuireWoods.

Increased number of insured
The Patient Protection and Affordable Care Act is designed to increase the number of insured, which will directly impact providers. "It is a reasonable assumption that a whole lot of volume will be entering the market, but it is too soon to tell," said Mr. Koonsman. It is uncertain ultimately how many newly insured patients will enter the market. If and when a large influx of patients hits the market, ASCs that have costs tightly under control will stand to succeed.

Dr. Curry observed that he does not expect more than a 2 to 3 percent increase in patient collections. "The ACA will not manufacture more patients, but it will shift the representation of our payer mix," he said.

Payer issues
Reimbursement is a pressing issue for both ASCs and group practices. There is a great deal of concern over government payers, but Mr. Koonsman sees the true pressure coming from another source. "My view today, the real destabilization is occurring in commercial insurance," he said. "Premiums are going to skyrocket." Patients are facing higher premiums, deductibles and copayments. Employers are considering becoming self-insured. As patients begin to make healthcare choices based on price, transparency will become paramount.

Joint ventures
As healthcare reform continues to move forward, ambulatory surgery center leaders are becoming concerned about what will happen to case volume as hospitals rapidly acquire physician groups. A hospital or health system partner is an attractive option. Partnering with a hospital lends ASCs strength in contract negotiation and a large guiding hand through changes in healthcare. At the same time, hospitals and health systems are turning to ASC partnerships to develop a strong, less cost outpatient strategy. While a few surgery centers are being converted to hospital outpatient departments, the majority of hospital ASC partnerships remain joint ventures.

Integrated care
Integrated care is a growing trend, especially as the pressure mounts to make the switch from a fee-for-service delivery of care model to a value-based model. Dr. Curry said that many hospitals will look to emergency department physicians and hospitalists to stand as leaders in the push for integrated care. "ER physicians are the first point of patient contact, combine this with hospitalists and this accounts for 85 percent of hospital admissions," he said. "I think most forward thinking hospital administrators will see ER physicians and hospitalists as a unit."

The number of hospitalists is increasing and collaboration with ER physicians could mean reduction in readmissions. As hospital performance metrics become tied to revenue, physician collaboration will mean cost and performance benefits for hospitals.

Both Dr. Curry and Mr. Koonsman observed that pioneer accountable care organizations are not reporting dramatic success. Few major health systems are investing time and money into ACO development while it remains uncertain if this will be a sustainable model. Many physicians remain reluctant to join as well. "There is no mechanism for physicians at a single hospital to collaborate. Everything is happening at a really high level," said Dr. Curry. "It needs to be more local. I don't see these overreaching efforts to be the solution."

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