Factors driving federal changes in ASC policy

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Three ASC leaders discussed the drivers of federal changes in ASC policy with Becker's. 

Editor's note: Responses were lightly edited for clarity and brevity. 

Susan Feigenbaum, PhD. Professor at University of Missouri-St. Louis economics department: Congress and CMS have begun to appreciate that the federal budget cannot accommodate a greater number of covered lives for longer life spans simply by raising premiums or cutting provider reimbursement. There has to be a new way to deliver medical services, and ASCs play an important role in this transformation. At some point, we will see CMS whittle down its "inpatient-only" procedure list and shift more procedures to the ASC environment. Likewise, the growth in Affordable Care Act plans and federal subsidy amounts will inevitably lead to greater cost-consciousness and a redirection of patients to lower-cost ASCs. Finally, the low interest rate environment over the past decade has escalated acquisitions of ASCs by private equity. Look for this trend to slow once the federal government tightens and interest rates rise.

Jeff Dottl. Principal at Physicians Surgery Center (Ventura, Calif.): As an insider, ASC policy seems pretty apolitical to me. It should be a lot easier to advance what ASCs are able to do. Who would oppose increasing access to more cost-effective care, lower risk of infection and better patient satisfaction? But our lobby is not nearly as powerful as other sectors of healthcare. Until the ASC industry can get the attention of some "first-tier" legislators, I think we will have a real uphill battle, especially for standalone legislation. 

Bo Neichoy, MD. Co-owner of Surgery Center of Amarillo (Texas): Large hospital systems and insurance lobbying are preventing more and more procedures from being deemed as outpatient. Better care at a lower price should be the focus. If a procedure can be done safely as an outpatient, and the patient is a good candidate for outpatient surgery, then CMS should leave that up to the individual physician's discretion. If a procedure is done as an outpatient in the hospital setting, I do not understand why it is not allowed to be done in an ASC.

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