The continuing migration of surgical procedures from hospitals to ambulatory surgery centers (ASCs) has health system leaders rethinking their outpatient strategies. But as hospitals and ASCs consider alignment opportunities and reimbursement dynamics, they also need to think about the technology that serves as a foundational layer for their success. ASCs are playing an increasingly prominent role in patient care, and it is essential that they employ a contemporary IT solution to manage patient billing, optimize efficiency in operations, and facilitate the flow of information among sites of care.
John Whitham, a Principal with ECG and a leader of the firm’s Healthcare IT practice, and Conor Gallagher, a Senior Manager in ECG’s Ambulatory Surgery practice, talk about the role that IT plays in a successful ASC strategy.
Why is it important for an ASC to have an effective technology strategy?
Conor – One thing that makes the ASC world so attractive is efficiency. It’s a lower reimbursement model, which is why CMS likes it and why more and more cases are getting channeled there. That’s a trend that will continue. So if you’re operating an ASC, your cost structure needs to be optimized in order to run a good ship. And that directly ties into having a seamless IT setup so that you can efficiently manage operations, get your claims out the door, get them collected on, get paid what you’re supposed to get paid, and have all the requisite clinical quality and patient information. Without the right systems in place, you’re compromising the efficiency of the ASC.
John – That can even be more critical for ASCs because they’re freestanding entities. Having the right IT platform is certainly helpful on the financial side, in terms of getting bills out the door, but it’s essential for effectively and efficiently facilitating the flow of information – from providers who are referring business into the ASC, and back out to the patient.
Conor – Great point. Some ASCs don’t have a good system and are still doing scheduling on an Excel spreadsheet, while other places are very advanced and have a system that talks to the practices and hospitals that are referring patients to them.
With such wide variance, how would you characterize the level of interoperability between these sites of care?
John – It’s certainly not seamless. And the discussion is different in this context than it would be when you’re talking about interoperability between a hospital and health system, their owned and employed physician group, and their affiliates. This adds a more complex layer because the hospital or referring provider may not have the same type of visibility into an ASC.
Conor – And that’s going to become an even bigger issue as Medicare continues to roll out programs like bundled payments. Take the Comprehensive Care for Joint Replacement (CJR) program. You have to be able to track the entire episode of care for a joint replacement case all the way through 90-day post-op. If a case gets referred to the ASC setting, the hospital’s still on the hook for reporting and capturing that episode of care so that they can report it and participate in any gainsharing. If you can’t “talk” to the ASC’s system or get any data back out, that’s going to be a problem.
In addition, ASCs struggle with accessing patient data following discharge. They often do not have reporting requirements unless there is a complication. So integration with the hospital IT system can enhance an ASC’s ability to further track a treatment’s clinical effectiveness and overall outcomes beyond the immediate procedure for which the patient was seen.
If ASCs implement one of the more common EHR platforms, would that resolve some of those issues?
Conor – To an extent, but the “big box” hospital system software packages were built to handle inpatient billing and information tracking, not the ASC billing methodology. Most of the big players now offer a solution, but it’s sort of backwards-engineered. They’re trying to accommodate ASCs that have been acquired by a hospital as opposed to being designed specifically for the ASC environment.
What is the experience like for ASCs that are using a platform that isn’t optimized for them? Is it simply more of a hassle, or are they losing money?
Conor – It might require a lot more effort and FTEs to try to get the bills out, so there’s an inefficiency that probably has a price tag attached to it relative to training and the time it takes to get something done. And in some cases you can’t maximize the reimbursement methodology specific to a particular payor because of the way you’re generating your bill. It’s like trying to put a square peg in a round hole.
There are also implications for patient flow. If you don’t have a system that integrates with physician practices or hospitals, patient scheduling could be difficult. Or there might be insurance verification issues, and you end up taking cases that you shouldn’t have and you’re not getting paid for them.
Are there EHR platforms designed specifically for ASCs?
Conor – There are multiple EHR solutions available specifically for ASCs, some more robust than others. However, the real challenge is interoperability among the ASCs and the physician practices and hospital systems they work with. What we often see is an EHR solution that serves one particular constituency well, but requires workarounds and manual intervention in an attempt to create seamless use of data across all constituencies – which is ultimately what you are looking for in an effective EHR solution.
How does an ASC decide what technology strategy and corresponding solutions are the best fit?
John– The advice we’d give to an ASC is the same as what we tell our hospital, health system, and physician clients – you need to think strategically about your technology platform, both clinically and financially, and how it’s going to help you meet your objectives. For a lot of organizations, technology tends to be an afterthought. But it needs to be thought of equally, because it’s going to lead directly toward the clinical and financial results that an organization wants to achieve.
Conor – That’s a good point. Because you can look at it from the other side of the coin in that, if you are going with a true out-of-the-box, ASC-specific information system, you might be missing some of the better qualities that the big-box products have in their EHRs. There are pros and cons to both sides, and I think John’s point is well taken – it’s really about strategically figuring out what you need, up front, and then finding in the best solution for it.
John Whitham works with the leadership of hospitals, health systems, and physician organizations to drive transformational change through the implementation and integration of healthcare technology solutions. His leadership has helped ECG’s IT practice become one of the most trusted voices in the healthcare industry.
Conor Gallagher is a proven leader who has spent more than 20 years working in healthcare and finance. He has worked with hundreds of ASCs and has a comprehensive understanding of the ASC revenue cycle and business operations.