OR Manager - December 2020 - 29

AmbulAtory
Surgery CenterS
Shifts in case mix bode well for future of outpatient surgery
B
efore COVID-19 emerged as
the biggest disruptor of 2020,
many ambulatory surgery centers
(ASCs) had been growing volume
and receiving Medicare reimbursements
for an increasing number of procedures.
Stopping elective procedures in
the spring was a significant setback,
especially for smaller, independent facilities,
notes a Global Healthcare Advisors
(GHA) brief, and resuming surgical
patient care has been challenging.
However, " there is an expectation of
pent-up patient demand that could allow
ASCs with the right cost management,
business mix, and geographic diversity
to quickly recoup lost volumes, " notes
GHA.
Growth opportunities
Some ASC leaders echo the optimism
of GHA. When asked by Becker's ASC
Review to share their visions of the next
5 years, 20 ASC owners, administrators,
and operators from across the US
cited similar trends influencing future
growth. Among them:
* The Centers for Medicare & Medicaid
Services (CMS) will continue to
remove procedures from the inpatient-only
list.
* More physicians will become owners
in ASCs.
* There will be more industry consolidation,
greater efficiency, and lower
costs associated with ASCs.
* Technological advances will enable
more complex procedures to be performed
on an outpatient basis.
Patients see ASCs as safer than
hospitals, with the added benefits of
shorter stays, minimally invasive techniques,
faster recovery, and lower
costs. This article offers projections for
growth as more cases shift to the outpatient
setting.
Shifts in service lines
Data from Sg2, a Vizient subsidiary and
healthcare consulting firm headquartered
in Skokie, Illinois, indicate that
currently about 83% of surgical procedures
are performed in the outpatient
setting-either hospital outpatient departments
(HOPDs), ASCs, or physicians'
offices. That outpatient shift may
ultimately hit a ceiling at something like
85% to 90% of procedures, but most of
the shift has already occurred.
" It is important to remember that
further inpatient to outpatient shift will
be tempered by increased patient complexity-patients
experiencing medical
comorbidities like diabetes, hypertension,
or obesity. In other words, much
of the low-hanging fruit has already
been plucked, " says Tony Guth, senior
director and surgery lead, Sg2.
For example, for general surgery,
Sg2 forecasts a 3% decline in inpatient
procedures and a 10% increase in outpatient
procedures over the next decade.
The majority of procedures such
as appendectomy, cholecystectomy,
and hernia repair are already being performed
in the outpatient setting.
Many women's health procedures
have shifted from inpatient to the
HOPD, but they remain tethered to the
hospital setting because OB/GYNs
often need to be closely tied to delivery
units. Higher risk patients will continue
to be treated in hospitals.
" What is more interesting
to us is what
we call the 'outpatient
shuffle' or movement
of ambulatory surgery
between different outpatient
sites of care-
HOPD, ASC, or office, "
Tony Guth
says Brianna Motley, principal and Sg2
System of CARE practice lead. " The
biggest wild card in this game is payer
policy activity driving toward site of service
payment parity. " According to Sg2,
inpatient procedures will decline by 3%
over the next decade while more costconscious
sites of care such as ASCs
will see a 25% growth in procedures.
Sg2 anticipates many of these procedures
now being done in HOPDs will
shift to ASCs or even physicians' offices.
Using
2019 baseline volume, Sg2
breaks down the ASC case mix as follows:
*
GI procedures, 40%
* ophthalmology, 20%
* pain management, 15%
* orthopedics, 13%
* ENT, 4%.
Continued on page 30
AMB u LATORy su R g ERy A D vis ORy BOARD
Jennifer Dickman, DNP, RN, CPN, Director, North Surgery Center,
UPMC Children's Hospital of Pittsburgh, Sewickley, PA
Claire Everson, RN, CNOR, CCAP, Clinical Educator and Consultant,
Bloomfield Hills, MI
Diane Fecteau, MSA, RN, CASC, NE-BC, Executive Director, Maine
Medical Center Scarborough Surgery Center, Scarborough, ME
Cynthia Hess, MSN, RN, FNP-C, RT(R)(CT)(ARRT), Director of Nursing,
Northeast Missouri Ambulatory Surgery Center, Hannibal, MO
Tracy Hoeft-Hoffman, MBA, MSN, RN, CASC,
Administrator, Heartland Surgery Center, Kearney, NE
Beverly Kirchner, BSN, RN, CNOR, CASC, Chief Compliance Officer,
SurgeryDirect, Highland Village, TX
www.ormanager.com
OR Manager | December 2020 29
http://www.ormanager.com
OR Manager - December 2020

Table of Contents for the Digital Edition of OR Manager - December 2020
