Staying viable in the healthcare industry can be challenging for surgery centers as the market consolidates and reimbursement falls.
During Becker’s 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in Chicago, Scott Becker, JD, publisher of Becker’s Healthcare, moderated a panel titled “The Best Advice for ASC and Practices Right Now.” Throughout the discussion, healthcare leaders spoke on changes they are seeing in their practice as well as how surgery centers can navigate the tides and turns of the healthcare industry.
Here are three key thoughts from the panel:
- New partnerships are taking hold.With the healthcare market undergoing major changes and moving toward value, new partnerships are coming into the mix. Large management companies are contracting with health plans and independent physician groups that are all aligned with the overall goal of lowering healthcare costs without compromising patient care.
“Partnerships are critical to success in the value-based healthcare world,” said Brett Knappe, vice president of business development and strategy for Medtronic Spine. A leader in the medical device space, Medtronic is looking to extend its reach and move beyond the classification as solely a device company. Medtronic has made a major effort to build positive relationships with payers over the last five years. The company is working with more with surgery centers due to their outcomes and quality of care.
“Seeing both complex and simple procedures moving to the ASC setting attracts our attention. There are unique and attractive things about the [outpatient] space,” Mr. Knappe added.
- Empowering physicians.Insurance companies are paying less and healthcare is expecting more from physicians. A higher workload does not always translate to higher reimbursement and therefore physicians have to be their own best advocates when contracting with payers.
“Your physician partners’ motivation drives tremendous results when it comes to negotiating with payers,” said Luke Lambert, CEO of Ambulatory Surgery Centers of America. “Physicians should show [payers] the data. Tell them you do 1,000 of these cases and you need X amount of money. Then, show them if they want to do the same number of these procedures at the hospital, you will be paying 5X.”
Since segueing from employment to independent practice, Neurosurgeon John Caruso, MD, president of Hagerstown, Md.-based Parkway Brain and Spine, has worked to build relationships with other physicians and empower independent providers to work together. With the overall aim of setting up a network of physicians, Parkway Brain and Spine has added several pain management physicians in recent years.
“What I am trying to do is set up an integrated physician network. We need to look at opportunities,” Dr. Caruso said. “I love the concept of independent physicians coming together and taking care of patients. That is what healthcare is to me and I enjoy doing it.”
- Many physicians are leaning toward employment.Hospitals can offer physicians a variety of benefits, including a work-life balance. As a new generation of physicians enters the field, surgery centers may struggle to bring in new blood.
Laxmaiah Manchikanti, MD, chairman of the board and CEO of American Society of Interventional Pain Physicians and Society of Interventional Pain Management Surgery Centers, said younger pain specialists are going to hospitals because of the higher pay. Many solo practitioners are burdened by the amount of documentation they must complete in their practice and the limited time spent with patients. However, Dr. Manchikanti said there is room for optimism regarding less regulations for physicians.
“I love MIPS [Merit-based Incentive Program]. The most important part is that you can make a bonus if you report on your patients,” he said. “There is hope; we are not getting as much regulation as we’ve had on a daily basis for the past eight years.”
ASCOA has formed partnerships with hospitals around the nation in regard to its surgery centers. Mr. Lambert noted 40 percent of its centers are aligned with hospitals as the market has consolidated in recent years.
“The fact hospitals get paid three times as ASCs for the same procedures enable them to gobble up practices and referral networks in a way that can put a squeeze on ASCs because centers aren’t a part of that. [Hospitals] have more to work with,” Mr. Lambert said.
While hospitals have more resources to offer potential recruits, the pendulum may swing back toward independence. The market is faring better for surgery centers in 2017 than five years ago. Mr. Lambert said. “Some of the markets have gone to the extreme [toward employment] and others are backing off a bit. We see that as a positive trend.”
Written by Mary Rechtoris | Becker’s ASC Review
The ASC industry today and new trends taking hold: 3 industry leaders share insights