Q: What do you see as some of the biggest challenges facing ASCs that you will discuss at the conference?
Todd Logan: It still comes down to reimbursement and volume. When I started in the industry, a wise man told me that volume doesn’t ensure success, but lack of volume ensures failure. Expanding on that thought is the fact that healthcare is local and threats to ASC volume and reimbursement in some geographic markets are not as big of a concern as they are in other areas. There may be a prevalence of hospital-controlled accountable care organizations (ACOs) in one market, which may be a threat to freestanding ASCs, but in other markets, ACOs are not being organized. As another example, I have seen payers with a significant share of covered lives in a specific market drive volume to their own ASCs and offer low rates to other ASCs in that market.
Another universal challenge tied to market threats is the ability to spread the message about how ASCs provide higher quality and lower cost, and then having that message resonate with payers. Too often, payers are still paying a significantly higher amount for the same procedure being performed by the same physician within the same zip code, with the only difference being the site of service. This is occurring because payers are not helping drive volume to the lower cost ASC.
We should all be strong proponents of more quality measures and reporting in our industry, including Consumer Assessment of Healthcare Providers and Systems (CAHPS®), so we can provide demonstrable proof of high quality and superior outcomes along with the lower costs provided in ASCs.
Q: How do these challenges pose a threat to the success of ASCs?
TL: There are many ASCs that are treading water financially and will be hard-pressed to withstand any more contraction of their top-line revenue, either through decreased volume or reimbursement.
Q: What do you hope attendees will take away from your panel discussion?
TL: It's all about the data. We are seeing innovative ASCs sharing cost and outcome data with payers to drive more volume and higher reimbursements. When I use the term payer, not only am I referring to traditional commercial, but also to patients and large companies that are bypassing the traditional insurance route and contracting directly with ASCs and providers for procedures. Without quality-based data, ASCs are much less likely to get the audience necessary to prove their facility is a viable alternative to the status quo.
Q: How do you see Amkai helping ASCs overcome some of these challenges?
TL: Our goal at Amkai is to ensure our customers have unequaled insight into their operations that then empower them to drive additional top-line revenue. We all know that more quality reporting is coming down the pike, and more and more of the data is clinical in nature (e.g., ASC-9, -10, -11 and -12 as well as other 2015 proposed quality elements).
Furthermore, when thinking ahead to CAHPS data elements, an ASC will need to measure such things as postoperative pain management, nausea and vomiting as components of the patient's overall experience. Simply throwing more paper and labor at these data collection requirements is not a tenable long-term solution.
Without the correct tools to collect and manage this data, ASCs will be at a competitive disadvantage vis-à-vis other ASCs and hospitals, and they will lack the requisite data to increase top-line revenue and overall profitability.
To schedule a time to meet with a member of the AmkaiSolutions team at the conference, contact us.
