By Sarah Martin, MBA, RN, CASC
Why Should My ASC Get Involved?
There are many legislative changes that have taken place in recent years that impact ASCs financial performance, with more in the works both at the state and federal level. The effective way to manage these changes, as opposed to having these changes manage your facility, is to have a voice in what happens through active involvement in your state ASC association and the national Ambulatory Surgery Center Association (ASCA).
Today’s ASC managers must now include awareness of proposed legislative changes to their list of tasks necessary to run their ASC. It also is imperative to share this knowledge and possible actions with your ASC staff and physicians to maximize the impact of grass roots initiatives. Before identifying these opportunities, however, one must first understand the current issues facing ASCs.
Current Issues Facing ASCs
Quality Reporting, Affordable Care Act, Reimbursement Changes, Hospital Strategies
The Affordable Care Act (ACA) continues to be a concern as to the impact it will have on ASCs. Accountable Care Organizations (ACOs) have been established and, for the most part, ASCs have not participated in these networks. While the increased access to care by the newly insured could potentially bring additional cases to ASCs, ACOs may direct those new patients elsewhere. The ASC Quality and Access Act of 2013 requires ASCs to provide data on quality outcomes to CMS, and ASCs need to anticipate implementation of value-based purchasing platforms, similar to what hospitals experienced several years ago. Like ASCs, hospitals reported quality outcomes and were then moved to reimbursement from CMS based on the results of their quality outcomes.
The continued disparity in Medicare payment between ASCs and HOPDs, negatively impacts free-standing facilities. HOPDs currently receive 81 percent more than ASCs for the same services. Managed care payers are forcing out-of-network strategies to be eliminated: it is becoming more difficult for ASCs to negotiate significant payment increases, implants are no longer being carved-out, and payment on percentage of charges is rare. There exist procedures that cannot be covered for payment in ASCs, but are paid for in HOPDs.
Managed care companies are incentivizing physicians to perform procedures in their offices, which impacts high-volume, low-supply cost cases such as GI and pain management. Add to this, the push for pricing transparency; while ASCs are still a lower cost provider, overpriced outlier ASCs reflect poorly on the industry overall and consumers are “shopping” pricing for their care.
Hospitals are buying ASCs, and joint ventures with ASCs and hospital partners have declined. Hospitals are also hiring physicians, which often deters physicians from using or having ownership in ASCs. This elimination of competition and control of referrals not only negatively impacts the ASC, but can also be to the detriment of the consumer, since market control can equal decreased competitive pricing.
In addition, national drug shortages hit ASCs harder, as access to these limited supplies tends to be provided to hospitals first, or the ASC is allocated minimal quantities.
For assistance in managing these challenges, it is important for ASCs to reach out to state and federal leaders representing them in their respective areas of the country.
What You Can Do Through Grassroots Initiatives
By definition, grassroots means at the local level and not waiting for leaders at the top to effect changes. ASC managers, staff and physicians can participate in grassroots initiatives such as writing letters to Congress, hosting a facility tour for state legislators at your ASC, or hosting an open house on National ASC Day. The ASC Association hosts Capitol fly-ins several times a year in Washington, D.C. which puts ASC personnel face to face with their legislators to discuss important issues. You can find a whole armory of resources at http://www.ascassociation.org/govtadvocacy/grassrootsadvocacy.
You Can Make a Difference
Grassroots efforts do make a difference, as evidenced by the recent revision to CMS Conditions for Coverage for radiology services in ASCs. Letters to Congress, Capitol Fly-ins and lobbying efforts by ASCA were the driving forces behind the change.
Membership and participation in state ASC associations is another avenue for effecting change on the state level since many bills that evolve into national issues start in the state.
You can support political action committees (PACs), by writing a check, regardless of the amount given. It is expensive for candidates to run for office; consequently contributing to a candidate or an incumbent through a PAC or directly is an important piece of advocacy. ASCA has a PAC, as do most state associations.
It is important for all ASC managers to participate in some manner of grassroots advocacy and to educate staff and physicians on issues facing the ASC both locally and nationally. This collective effort is necessary to ensure the continued success and viability of the ASC industry as a whole.
Make sure you play your part.
Sarah Martin has over 34 years experience in healthcare, focusing on ambulatory services for the past 15 years. A registered nurse with an MBA, she holds the CASC credential and has served on the boards of ASCA, AAASC, Tennessee Ambulatory Surgery Center Association (TASCA), and the ASC Quality Collaboration. She is a frequent speaker at national ASC meetings; has held SVP and VP positions in both operational and clinical/quality roles with national ASC companies; and is a surveyor for AAAHC.