The ASC's changing role in value-based care: 6 questions with Dr. Gerald Maccioli


Gerald A. Maccioli, MD, chief quality officer of Envision Healthcare and medical director of Envision's Healthcare Center for Quality and Patient Safety, has nearly three decades of experience in clinical and business leadership. Here, he shares his thoughts on the role of ASCs in value-based care, technological advancements on the horizon and more.

Note: Responses have been lightly edited for style and clarity.

Question: What are your reactions to the recent outpatient prospective payment system news from CMS?

Dr. Gerald Maccioli: It’s very interesting how the Centers for Medicare & Medicaid Services is pushing price transparency for hospitals vis-à-vis payer rates. For consumers, it might seem favorable. If I operated a hospital, I would find this onerous, considering it would require hospitals to disclose charges for all items and services. Contracting and rates are very complex, and it’s not fair to just publish a rate as an isolated number. Removing total hip replacements off the inpatient-only list was an appropriate step for certain patients, and including total knee replacements on the ASC list is positive as well.

Q: Is there anything you think CMS should have proposed but didn't?

GM: CMS should have lifted the suspension for ASC-1 Patient Burn, ASC-2 Patient Fall, ASC-3 Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant and ASC-4 All-Cause Hospital Transfer/Admission, as there is value in publicly reporting these patient safety measures. In addition, having the hospital outpatient department report these same measures will further align the programs and provide more meaningful comparisons.

Q: What quality issues do you see ASCs struggling with?

GM: The formal cost reporting will be overly burdensome to ASCs. The clinicians and staff at ASCs need to focus on providing patients with the highest quality of care. Without the right resources and support, additional administrative responsibilities can take away from time spent with patients.

Q: How would you recommend ASCs address these?

GM: Transparency in pricing is satisfactory, but it needs to be standardized and adjusted to account for multiple factors such as geographic location. ASCs need a stronger voice and must serve as a partner in making these decisions, as they understand the impacts certain regulations will have on operations, and ultimately, the delivery of high quality, patient-centered care.

Q: What technological advancements do you think are on the horizon for ASCs?

GM: The continued growth and utilization of nonopioid analgesics and regional nerve blocks will be part of the equation for ASCs moving forward. In addition, I predict that biometric sensors (‘super fitbits’), where patients are monitored electronically postdischarge, are in our future and they will facilitate the growth of procedures in the ASC setting.

Q: What are some ways ASCs can engage more effectively with their patients?

GM: Patient engagement is critical in ASCs and across the entire spectrum of healthcare delivery. We know that meaningful and effective communication with patients throughout their care journey is essential, and ASCs are already leveraging technology to enhance communication with patients. I expect smartphone applications with detailed information, instructions and chat functionality to become common in the next few years. ASCs are on the cusp of advancements like these and are in a position to lead the way.

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