The pandemic highlighted the role ASCs play in the delivery of safe and cost-effective care.
It's an exciting time to run an ambulatory surgery center. Many of the short-term changes ASCs made during the pandemic will have long-lasting and positive effects. Facilities also remain well-positioned to capitalize on the growing demand for outpatient surgical care. Elizabeth LaBouyer, executive director of the California Ambulatory Surgery Association, recently provided insights into how ASC leaders expertly adapted to unpredented circumstances over the past year, and how the pivots they made could improve patient care for years to come.
What pandemic-related challenges have surgery centers been forced to manage?
There have been a series of them, including ensuring access to PPE, responding to changing guidelines and shutdowns of elective surgical procedures. Surgery center leaders quickly designed and implemented new protocols to reduce the risk of COVID-19 exposure for patients and staff, and managed budget challenges that came from reduced caseloads. Additionally, ASCs had to adopt new virtual systems to communicate with patients and their caregivers differently to reduce unnecessary in-person interactions. ASCs typically have a high volume of cases and rapid OR turnaround times, so it was a business shift to plan for extra time between procedures, and deal with more canceled cases due to COVID-19 screenings.
How will overcoming these challenges ultimately improve the care ASCs provide?
Some of the remote communication practices have been very useful for patients. ASCs are sending them reminders and updates by text message and informing their caregivers of the status of procedures. I'm certain that many of these new communication practices will remain in place. ASCs are designed to be nimble and responsive, so they were able to pivot quickly in handling scheduling adjustments and implementing new safety protocols specific to COVID-19. The challenges of the past year have provided new opportunities to rethink infection prevention practices and ensure the safest space possible for surgical procedures.
How will the pandemic positively impact utilization of ASCs?
Surgery centers have provided a safe alternative site for surgical procedures that kept patients out of hospitals who didn't need to be there. That's been good for many reasons. As hospitals faced a surge of COVID-19 patients, ASCs were able to take on some cases the hospitals didn't have the resources to handle. This coordination between hospitals and ASCs on a regional level helped address community care needs and increased awareness of how ASCs serve a critical role in the healthcare delivery system. Moving forward, hospitals will increasingly view ASCs as important partners.
Additionally, from the consumer perspective, ASCs provided a space for surgical procedures that was free from COVID-19 patients, and that was an attractive option. Some patients who may have previously seen hospitals as a preferred setting may now view ASCs as a safe alternative. It's likely we will see a continued shift of more patients who can be safely treated in an ASC make that choice.
What procedures will migrate from inpatient settings to ASCs in the next five to 10 years?
CMS has added 267 codes to the ASC Covered Procedures List for 2021 and is moving toward elimination of the inpatient-only list by 2024. In 2020, Medicare began paying for total knee replacements performed in ASCs. This year, Medicare added total hips to the ASC-approved list. The increasing volume of total joints performed in ASCs represents significant cost savings for patients, Medicare and private payers. Additionally, Medicare has approved a series of coronary intervention procedures for ASCs, a move that opens up great opportunity for diagnostic and preventive interventions to be done more efficiently.
Research has shown that the utilization of ASCs will result in a projected annual savings for Medicare of $12 billion by 2028. But it's not just Medicare that wants the cost savings. We're seeing private payers such as Anthem and UnitedHealthcare enact policies that direct surgical procedures into the ASC setting unless there is a reason based on patient acuity or geography that the case must be done in an HOPD.
How will the relationship between hospitals and ASCs evolve in the years ahead?
We're definitely seeing increased collaboration rather than competition between the facility types. Through the course of the pandemic, ASCs had to coordinate on a local level with county health officials and healthcare systems to track resources and make plans to address surges in COVID-19 patients. The pandemic accelerated the movement away from large traditional institutions, and expedited the move toward technology, telemedicine and ASCs — and showed the transition can be successful. Health systems are recognizing they must have ASC connections moving forward, and will likely pursue additional investments and partnerships in the future.