Trends Impacting the ASC Landscape: 5 Things To Know
According to McKinsey research, nonhospital-provider segments are primed for growth and could account for almost 55 percent of projected profit pools by 2021. This includes everything from diagnostics, pre-, non-, and post-acute services, surgery centers, physicians and other healthcare professionals.
The pre-acute, non-acute care providers segment (which includes ambulatory surgery centers) is estimated to reach $26 Billion in EBIDTA in 2021 with an annual growth rate of 5-6% from 2017 to 2021.
Different healthcare trends in the areas of utilization, reimbursement, and efficiency will shape the future. In a rapidly changing healthcare landscape, it is critical to understand these trends; otherwise, surgery centers may be missing opportunities to optimize payment and enhance their bottom line.
As the US population ages, payers are seeking to keep the elderly out of hospitals and skilled-nursing facilities if lower-cost settings can provide comparable or better care.
According to the US Census Bureau, from now to 2025, the population aged 65 and older will grow more than four times faster than the total population will grow. Hence, outpatient sites that offer options like 24/7 or weekend care will be poised for growth as they capture the healthcare demands of an ever-graying population.
ASC Reimbursement Trends
In 2019, CMS awarded ASC’s a 2.1 percent reimbursement rate increase on average per procedure.The CMS final rule also included several provisions to level the playing field by raising ASC’s to the higher rate used for hospitals’ outpatient departments and ensuring better reimbursement for devices. The Ambulatory Surgery Center Association (ASCA) estimates that the latter means that ASC’s can now afford to provide 142 additional procedures to Medicare beneficiaries.
In addition, the definition of "surgery" has also been expanded under the ASC payment system to include select "surgery-like" procedures, such as 12 cardiac catheterization procedures. CMS added five additional cardiac catheterization procedures to the ASC covered list as well.
Improvements in Efficiency
Ambulatory surgery centers are realizing the benefits of scale through their efficiency.
For example, data suggests that the average time for an ambulatory-surgical visit for a Medicare patient in an ASC was 25 percent to 40 percent shorter than for those in a hospital’s outpatient department (HOPD) and that the procedures in ASC’s took 17 percent less time.
In addition, there is a growing demand for “one-stop shopping” from consumers and suppliers. On the consumer side, patients want care that is affordable (especially considering the increases in patient financial responsibility), competent, and convenient. This healthcare-on-demand preference is seen in the rise of ASC’s, urgent care centers, and retail clinics, among others.
To address this need, an increasing number of ASC’s —typically larger operations — are adding ancillary services. These include imaging, pathology, and physical therapy. Such investments can make an ASC more attractive to patients, physicians, and potential business partners.
Millennials’ Mindset Towards Healthcare
The TransUnion Healthcare multi-generational survey found that approximately half of Millennials (46%) would be more apt to pay their medical bills if they were provided an estimate of their healthcare costs at the point of service.
In addition, 57% of Millennials self-reported either ‘no understanding’ or ‘limited understanding’ of their healthcare insurance coverage, compared to 42% of Baby Boomers who said the same.
Despite challenges and trends healthcare providers are facing, Millennials are indeed interested in responsibly paying medical debts, while at the same time, healthcare providers will need to engage patients early.
Increase in Self-pay patients
The volume of direct consumer payments to providers increased 58 percent from 2013 to 2016, according to InstaMed’s annual report. This means that the patient is now the payer and is a very important financial class.
A TransUnion analysis showed that 30% of self-pay accounts (those patients without health insurance or those that have a patient balance after insurance) will generate more than 80% of the self pay revenue collected by hospitals. Another analysis by TransUnion Healthcare also revealed that patients experienced an 11% increase in average out-of-pocket costs in 2017.
ASC’s which can use these trends to their advantage and implement improvements to their revenue cycle strategies will be better poised for future financial growth and boosting their bottom line.