Jennifer Rock-Klotz, M.B.A.; Nicholas M. Halzack, M.P.H.
ASA Monitor 08 2016, Vol.80, 14-17.
Jennifer Rock-Klotz, M.B.A., is ASA Health Policy Analyst.
Nicholas M. Halzack, M.P.H., is ASA Senior Health Policy Analyst
ASC Locations and Consolidation
Three states with the most ASCs per capita (Medicare fee-for-service beneficiaries) are Maryland, Wyoming and Georgia (with the least are Vermont, District of Columbia and West Virginia).7 Georgia also had the highest increase in the number of ASCs in its state between 2010 and 2015 (43), followed closely by New Jersey (42) and then New York (30). Only 11 states increased the number of ASCs of at least 10 between those years, and those 11 states are spread across geographic regions in the United States with a wide range in the number of ASCs per capita. A study published in 2015 found that freestanding ASCs were twice as likely to open in markets that had little competition for outpatient surgery, and about four times more likely to open in urban areas with high per capita income.8 Thus, policymakers may consider strategies to promote ASC diffusion in disadvantaged socioeconomic environments.
Within the for-profit ASC market, AMSURG Corp.,1 Surgical Care Affiliates, Inc., HCA Holdings Corp. and Surgery Partners, Inc. are the largest public companies that own freestanding ASCs, respectively (Table 2). In total, these four companies only account for approximately 12 percent of the ASCs in the United States. Sheridan Healthcare’s (acquired by AMSURG Corp. in 2014) anesthesi-ology services directly accounted for 71 percent of Sheridan’s revenue, and approximately 2,900 anesthesia professionals provided more than 1.25 million anesthetic cases at more than 320 facilities in 19 states.9
New Policy Proposal Affecting ASCs
As anesthesia techniques and surgical technology continue to improve and as the pressure to decrease health care costs escalates, the demand for outpatient surgeries may grow at a faster rate compared to the past three decades. Therefore, policy proposals affecting ASCs deserve special attention from perioperative physicians. MedPAC recently provided two recommendations for Congress. First, MedPAC recommends that the ASC payment increase be eliminated for 2017 to control costs; MedPAC predicts that payments will remain stable. If passed, MedPAC expects this would reduce federal spending by about $50 million in the first year. Second, MedPAC recommends that ASCs submit cost data to compare Medicare payments to provider costs and estimate if a substitute input price index would be a suitable alternative for ASC cost. As of June 6, 2016, Congress has not addressed these recommendations. If passed, these proposals may reduce revenue in Medicare-certified ASCs and create an additional administrative burden related to collecting and submitting cost data.
Postscript: The ASA 2016 ANESTHESIA ALMANAC
Some of the data in this article can also be found in the ASA® 2016 ANESTHESIA ALMANAC, a compilation of perioperative data for the United States recently published by ASA Health Policy Research (HPR). In addition to information about ASCs, it includes information about hospital-based surgical volume, anesthesia utilization trends, anesthesia workforce characteristics and practice acquisitions. It is free to access and can be downloaded from the HPR webpages (www.asahq.org/resources/health-policy-research) or from the ASA Publications webpage (pubs.asahq.org). We encourage you to download it and submit any comments or suggestions to us at ask.HPR@asahq.org.
1As of June 15, 2016, AMSURG Corp. and Envision Healthcare Holdings, Inc., announced a merger agreement. The combined company will be named Envision Healthcare Corporation. Source: Envision Healthcare Financial Release www.businesswire.com/news/home/20160615006526/en/Envision-Healthcare-AMSURG-Announce-Transformational- Merger.
Ambulatory Surgery Center Association. Ambulatory surgery centers: a positive trend in health care. ASCA: Ambulatory Surgery Center Association website.https://higherlogicdownload.s3.amazonaws.com/ASCACONNECT/5c8d6e18-6d12-4637-bbef-a2afcfc1c019/UploadedImages/About%20Us/ASCs%20-%20A%20Positive%20Trend%20in%20Health%20Care.pdf. Published 2012. Accessed June 14, 2016.
2016 Anesthesia Almanac. Schaumburg, IL: American Society of Anesthesiologists; 2016.
Ambulatory surgery centers. CMS: Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/ASCs.html. Updated April 10, 2013. Accessed June 14, 2016.
Munnich EL, Parente ST. Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Aff (Millwood). 2014;33(5):764–769. doi:10.1377/hlthaff.2013.1281.
Meyer H Replacing joints faster, cheaper and better? Modern Healthcare website.http://www.modernhealthcare.com/article/20160604/MAGAZINE/306049986. Published June 4, 2016. Accessed June 14, 2016.
Leader S, Moon M Medicare trends in ambulatory surgery. Health Aff (Millwood). 1989;8(1):158–170. doi:10.1377/hlthaff.8.1.15
Medicare Payment Advisory Commission. March 2016 Report to the Congress: Medicare Payment Policy.http://www.medpac.gov/documents/reports/march-2016-report-to-the-congress-medicare-payment-policy.pdf. Published March 2016. Accessed June 14, 2016.
Suskind AM, Zhang Y, Dunn RL, Hollingsworth JM, Strope SA, Hollenbeck BK . Understanding the diffusion of ambulatory surgery centers. Surg Innov.2015;22(3):257–65.
AMSURG CORP. Form 10-Q: for the quarterly period ended March 31, 2016. U.S. Securities and Exchange Commission website.http://www.sec.gov/edgar/searchedgar/companysearch.html. Filed May 6, 2016. Accessed June 15, 2016.