Medicare, commercial payers and employer groups are demanding reduced healthcare costs. Employer groups are tracking their healthcare spend and holding payers accountable, comparing cost differentials between sites of service and demanding accountability from payers. Providers must be responsive and proactive as payers and employer groups seek alternative sites of service and providers that can demonstrate value and the ability to reduce cost while offering high-quality care to their members and employees.
Rapidly Changing Ambulatory Surgery Center (ASC) Regulations
Surgery is one of the most expensive cost centers in the hospital, but it is also one of the highest revenue generators. The momentum to support and direct surgery out of the hospital setting to ASCs presents significant opportunity for CMS and commercial payers to realize savings. The number of CMS rule changes supporting surgery migration and new insurance policies and benefits that financially incentivize and reward providers for delivering cost-effective care are growing. These changes circumvent physician employment by hospitals and mitigate primary care strategies. Migrating surgery to ASCs presents a significant threat to the financial health of a hospital or health system if a sound ASC strategy is not in place.
As rules and policies change, technology and surgical techniques advance, incision sites become smaller and new opportunities emerge to access extended postoperative recovery care in an outpatient setting, ASCs continue to be a meaningful part of the solution to reduce overall healthcare cost. They are well positioned to realize increased volumes and financial success, while hospitals are at eminent risk of surgery migration and financial losses.