June 19, 2024

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THIS WEEK'S ARTICLES

BSMH/Compass Initiative Opens Two New ASCs, More to Come

New ASC Opens on Bucolic Alabama Campus

Growing an ASC From the Ground Up - Sponsored Content

UChicago Medicine Enters Indiana in a Big Way

ASC Industry Mobilizes Against CMS Prior Authorization Demonstration Project

 

BSMH/Compass Initiative Opens Two New ASCs, More to Come

A large health system and ASC management company are teaming up to partner with physicians on cost-efficient outpatient surgical facilities.

Springfield-ROSCBUSY JOINT Springfield Regional Outpatient Surgery Center, the first joint-venture ASC among BSMH, Compass and local physicians, is a 12,000-sqaure-foot multispecialty ASC that features four ORs and a procedure room. | Compass Surgical Partners

Almost exactly a year ago, Bon Secours Mercy Health (BSMH), one of the 20 largest health systems in the U.S., and ASC management company Compass Surgical Partners announced a long-term strategic plan to partner on opening multiple ambulatory surgery centers in 2024 and beyond. BSMH especially lauded Compass’ expertise in creating “patient-centered” ASCs that offer convenience and cost-efficiency, while Compass expressed excitement about the opportunity to provide its expertise and operational platform to BSMH.

A year later, the partners have launched two ASCs, with more to come. In February, they opened Springfield (Ohio) Regional Outpatient Surgery Center, a joint venture among BSMH, Compass and local physicians. The 12,000-sqaure-foot multispecialty ASC, which houses four ORs and a procedure room, will offer neurosurgery, orthopedics, podiatry, plastic surgery, interventional pain management, OB/GYN, gastroenterology and general surgery procedures, according to the stakeholders.

“This state-of-the-art center will offer patients in our local community an additional option for care, one that is focused on accessibility and careful attention to individual surgical needs,” said Adam Groshans, president of Mercy Health – Springfield, part of the BSMH system. The ASC was seeking accreditation from the Accreditation Association for Ambulatory Health Care (AAAHC) and certification from Medicare, and is managed by Administrator Brooke Moats, BSN, RN, CNOR, a surgical leader at hospitals and outpatient centers for 20 years.

In April, the second BSMH/Compass ASC opened in Greenville, S.C., again in partnership with local physicians. The 20,000-square-foot Millennium Surgery Center will offer same-day orthopedic surgeries, otolaryngology interventions and pain management procedures. The ASC expects to secure AAAHC accreditation and Medicare certification by mid-May.

Ortho procedures performed at the ASC will include total joint replacement, sports medicine, fracture treatment and interventions for the hands, elbows, feet, ankles and spine. A Stryker Mako Robotic-Arm Assisted System will be used during total hip and total knee replacements. Matt Caldwell, market president for Bon Secours St. Francis Health System, part of BSMH, says Millennium Surgery Center will be the first ASC in the Upstate region of South Carolina to offer outpatient joint replacements.

New ASC Opens on Bucolic Alabama Campus

Surgery is just one aspect of USA Health’s drive to provide more holistic health services, improve patient access and train the next generation of providers.

Baldwin-County-SCTRANQUILITY BASE Baldwin County Surgery Center, part of the eight-acre Mapp Family Campus along with a large medical office building, is situated in a peaceful setting with numerous outdoor amenities and, of course, ample parking. | USA Health

USA Health, the only academic health system in the upper Gulf Coast region that ranges from Florida to Texas, opened a new ASC in Fairhope, Ala,, last year that takes advantage of its outdoor surroundings and other amenities.

The 24,000-square-foot Baldwin County Surgery Center sits on a serene eight-acre complex called the Mapp Family Campus, named for Louis and Melinda Mapp, who donated the land to the University of South Alabama, which runs USA Health. The six-OR ASC also features two procedure rooms, with service lines including pediatrics, orthopedics, urology, general surgery, gastroenterology, ophthalmology, podiatry and ENT. USA Health and ASC operator Surgery Partners developed the project, which the Alabama Certificate of Need Review Board unanimously approved in 2021.

The ASC joins the three-story, 50,000-sqaure-foot Mapp Family Campus Medical Office Building, opened in 2022 and staffed by providers from USA Health and Baldwin Family Medicine.

Outside, what is described as a peaceful campus includes walking paths, water features, outdoor gathering areas and an amphitheater. There’s also a focus on the campus on wellness, education and nutrition, with USA Health providers incorporating “health and wellness strategies for patients along with traditional medicine,” according to the health system. Inside the medical office building, a demonstration and teaching kitchen allows providers to engage patients in healthy-eating classes with the goal of helping them lead longer, better lives.

A primary motivation for the ASC project is to provide better access to surgical care and other health services for the local community. “This much-needed facility will improve access to exceptional healthcare, and it will bring our specialists closer to the people of Baldwin County,” says USA Health CEO Owen Bailey, MSHA, FACHE.

Adds John Marymont, MD, MBA, vice president for medical affairs and dean of the Frederick P. Whiddon College of Medicine, “We are proud of the partnerships our academic health system has established with community physicians on the Eastern Shore. This new surgery center is an example of how our successful collaborations expand access to health care and benefit those who live and work in Baldwin County and surrounding areas.”

The campus is also serving as a location for educating and training new healthcare providers to help alleviate shortages in the region. USA Health says its academic physicians are using some of the technologically advanced surgical equipment available at the ASC to provide that education and training.

 

Growing an ASC From the Ground Up
Sponsored Content

It takes an experienced team working collaboratively on tailored solutions to create a successful center.

The world of ambulatory surgery centers (ASCs) continues to evolve as new facilities are coming online and plans are underway for new launches, renovations and retrofits to provide same-day surgery in communities across the country that have expressed the need for these special outpatient surgeries in a safe and convenient environment. But building or renovating a successful ASC is a complex journey – and it starts long before construction begins.

Finding the right partner on this journey is the first step since the challenges of each individual project is unique and requires a custom approach. Stryker has a dedicated ASC team in place and starts by listening and learning about these unique challenges and goals. From there, a tailored solution that fully leverages goal-driven strategies, product solutions and flexible financial planning is set.

In fact, the journey to growing an ASC involves an eight-step process developed by Stryker. With 30 years of experience and a strong portfolio of products and services, Stryker has delivered tailored, comprehensive solutions and helped design and outfit more than 15,000 ORs.

The first phase starts up to 24 months before opening with the property acquisition, which can include existing structures. The right location is key to success. Next, working with Stryker, the scope of the project is determined in the second phase where experience and market data can right-size the planned facility. Choosing an architect is perhaps the biggest decision of all in the third phase – and it’s important that trusted partners with ASC design experience are tapped.

Guidance on budget planning and equipment will move the project along in the fourth phase with smart financing options offered by Stryker to offer flexibility. The next two phases will focus on room layout design and clinical specifications – about a year before opening – to ensure that the right layout and right equipment is chosen for the specialty surgeries planned. Experience in how multi-specialties function, including the constantly evolving orthopedic specialty, ensures that the right decisions are being made.

Construction and installation move forward in the final two phases of a project and the collaborative team focuses on important planning and strict attention to detail as the build takes shape. Stryker’s network of trusted partners provides experience and expertise as well as offers a comfort level for these important steps. Their eight-phase program offers a single source of guidance to help launch customized ASCs with access to a comprehensive portfolio and deep understanding of the complex ASC landscape.

For more information, go to Ambulatory Surgery Center (ASC) | Stryker

 

UChicago Medicine Enters Indiana in a Big Way

Its first freestanding facility in the state features an ASC... and so much more.

Following 20 months of construction, UChicago Medicine last month opened UChicago Medicine Crown Point, a new two-story, 132,000-square-foot multispecialty care center that includes an ASC and a “micro-hospital.”

The center, which opened last month in Crown Point, Ind., becomes the largest off-site facility in the UChicago Medicine academic health system, and its first freestanding facility in the Hoosier State. The development came in response to a UChicago Medicine market assessment that found approximately 15% of Northwest Indiana patients were traveling outside the region for medical care — and 20% of them were UChicago Medicine patients traveling to Chicago and its near suburbs.

Mark Anderson, MD, PhD, UChicago Medicine’s executive vice president for medical affairs, says the health system is embracing a “hub-and-spoke approach to care delivery” to better serve communities beyond its central Hyde Park campus in Chicago, which is over 40 miles away from the new facility. UChicago Medicine will employ approximately 200 clinical and nonclinical staff at the Crown Point location, where it expects more than 110,000 patient visits annually.

Healthcare real estate developer PMB states it executed all aspects of the project, from locating and purchasing the land to hiring and coordinating with the architecture and construction firms. “It's really about shifting risk and all execution responsibilities to a third party,” says Jake Rohe, PMB’s managing partner and president. “Healthcare institutions are in the business of delivering care in a very regulated and dynamic environment. Partnering with a dedicated healthcare developer can augment their resources and provide all the necessary controls to the health system. We can get the same project and scope of work to market faster and more efficiently, and we can do it at a better price point while still operating in a true partnership with the sponsoring health system.”

A design team from global agency Perkins&Will focused on creating a patient-focused experience that reinforces UChicago Medicine’s identity and brand. The health system says the facility is bright and welcoming, with a double-height entry featuring large paper cloud lights, with the official state bird of Illinois and Indiana, a red cardinal, hanging among them. The entry leads to imaging, the ASC and a cancer center that UChicago Medicine describes as one of only two comprehensive cancer centers in Indiana, with services including infusion therapy, radiation, imaging, medical and surgical oncology.

The building houses medical offices, building support and shelled space for future growth. The eight-bed micro-hospital has its own entrance and waiting area adjacent to the main entrance. The facility also includes a small emergency department.

UChicago Medicine and UChicago Medicine Comer Children’s Hospital physicians and specialists are on site, including those who work in digestive diseases, heart and vascular, neuroscience and orthopedic surgery.

Take a closer look UChicago Medicine Crown Point by viewing video from the grand opening event that took place inside the facility.

 

ASC Industry Mobilizes Against CMS Prior Authorization Demonstration Project

Five procedures and 40 codes are under scrutiny for potential abuse and fraud.

The ASC industry is expressing disapproval regarding CMS’ proposed plan to develop and implement a five-year prior authorization demonstration project for a variety of ASC services that it says could be considered cosmetic rather than medically necessary.

At issue is CMS-10884, Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services. The service categories targeted in the project are blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty and vein ablation procedures. These are these same services for which CMS established a still-ongoing nationwide prior authorization process for HOPDs in its Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule.

CMS’ concern is about the possibility of improper or fraudulent payments. It says its data from 2019 to 2021 shows the targeted procedures increasingly shifted to ASCs and is troubled about what it characterizes as “unnecessary utilization” moving from the now more restricted HOPD setting to the ASC setting. With that in mind, CMS wants to investigate the application of a prior authorization process for these services at ASCs that is similar to that in place at HOPDs, where it has reduced spending on the procedures by 28%.

“Implementing prior authorization requirements in the ASC setting would help prevent that shift in unnecessary utilization and potential fraud, waste and abuse,” writes CMS, which says it selected the targeted services for inclusion in the demonstration based on problematic events, data, trends and potential billing behavior impacts.

“The proposed demonstration will help ensure eligible treating providers in ASCs are only performing the targeted services for beneficiaries in accordance with Medicare guidelines, by requiring them to submit a prior authorization request and obtain a provisional affirmation before providing a service or be subject to prepayment review and potentially be denied payment if services are deemed ineligible,” writes CMS. “We see the demonstration as another step in our overall approach to enhancing our ability to separate problematic providers from those providers proactively working to comply with our coverage and documentation requirements, thus helping prevent fraud, waste and abuse.”

Unlike the nationwide HOPD process, the ASC prior authorization demonstration project is limited to 10 states: California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia and New York. There is much more detail on the requirements in CMS’ supporting statement. CMS plans to start the demonstration on Nov. 1, 2024, and it would expire on Nov. 1, 2029.

William Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), submitted comments regarding the issue to CMS on Apr. 16. “ASCA supports efforts to save the Medicare program and taxpayers additional money, but this proposed demonstration will not accomplish what it claims to, namely, thwarting ‘improper or fraudulent payments,’” he writes. “ASCA opposes this demonstration because it will be a waste of taxpayer dollars and an increased and unnecessary burden on ASCs.”

He wrote that CMS’ premise that the demonstration process will address Medicare fraud is unnecessary because it already has a mechanism for that in place in the Medicare Fee for Service Recovery Audit Program. “This demonstration appears to be a solution in search of a problem — imposing additional burden on providers and additional cost on the Medicare program and taxpayers without evidence of widespread fraud in the ASC community,” wrote Mr. Prentice. He added that of the 40 codes listed for the five procedures, only one — J0585 — saw an increase in the ASC setting from 2019 to 2021, at just 1.5 percent, while 21 of the 40 had 100 or fewer claims nationwide, and five have a payment indicator N1 and are not separately payable in the ASC setting.

“If CMS wishes to establish a policy that requires additional burden on facilities, it should clearly delineate the criteria and exclude procedures that fall below a certain volume threshold or overall spend within the Medicare program,” wrote Mr. Prentice. “Then, when evaluating increased utilization, CMS should specify a percentage increase that will trigger the prior authorization. Based on the list that has been provided, there is a concerning lack of effort in identifying procedures that merit such concern.”

Added Mr. Prentice, “Medicare reimbursement is not keeping pace with costs, and we object to this additional burden on the ASC community without a clear indication that the demonstration is needed.”

ASCA organized sign-on letters in opposition to the project for state associations and specialty organizations that 27 of the former and 16 of the latter have signed. OSM

 

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