Managed Healthcare Executive - February 2009 - (Page 26) { HOSPITALS AND PROVIDERS } than at ASCs (0.42%). Although many ASCs do accept Medicaid, those patients usually end up in hospitals, often after treatment in an emergency room. From the health plan/payer perspective, it’s great that ASC outpatient procedures cost less. In fact, Medicare pays ASCs 59% of what it pays hospitals because hospitals have such high overhead. The bigger problem is the overall increase in utilization and determining the medical necessity of many of the procedures. “There is no question that the increased utilization of healthcare services is one of the biggest drivers in overall healthcare costs,” says Robert Zirkelbach, AHIP director of strategic communications. “The United States has an aging population that is using more healthcare services overall than it had in the past, and unhealthy lifestyle choices also are contributing to the number of health conditions that drive increased utilization.” Are ASCs exacerbating that trend? Another issue that needs to be addressed is physician self-referral to facilities they own. The 1989 Stark regulations do not ban selfreferral to a specialty hospital or ASC. “For example, utilization of high-tech imaging services tends to be higher among physicians who own imaging equipment,” Zirkelbach says. “There is a direct correlation there, so as we look at payment reform in general, we need to ensure patients are getting the right care, in the right setting—as opposed to simply reimbursing for whatever amount of services a physician provides.” THE DRIVING FORCES The reasons for the increase in the total number of outpatient procedures aren’t difcult to discern. Procedures that required a long inpatient stay in previous years now can be performed on an outpatient basis, thanks to improvements in pharmaceuticals and medical science. In many ways, the situation mirrors the dilemma brought about by advance26 FEBRUARY 2009 On the contrary, hospitals should use this as an opportunity to make their own facilities more appealing to doctors, some experts believe. “Hospitals now are presented with a strategic opportunity to increase the loyalty of their admitting physicians and optimize the ‘surgeon experience,’” says EXECUTIVE VIEW Bob Gift, director of operations improveA study of outpatient and ment with IMA Consulting. “For exdiagnostic procedures by the ample, they should ensure that surgeons PHC4 showed that 30.7% of can get their patients admitted quickly such procedures statewide and easily, that operating room time is were performed in ASCs in available to them, and that the operat2007, up from 10.2% in 2000. ing room sta knows the way a surgeon works and has the right instrumentation Outpatient procedures tend ready for them.” to be among the most profitGift believes that the best attitude hosable services a healthcare facilpitals could take is, “If you can’t beat ’em, ity can offer. join ’em.” The percentage of uncom“As some of the physicians get closer to pensated care performed at retirement age, hospitals can work with hospitals is considerably higher the remaining doctors to convert a free(2.27%) than at ASCs (0.42%). standing ACS into a joint venture,” Gift says. “The hospital might have capital that Health plans and other payers have the physicians lack, as well as extensive long been concerned about the true experience with managing a healthcare medical need for expensive imaging ser- facility.” vices in some cases, and the increased Patients would likely bene t from utilization of such costly procedures has such joint ventures too. If more ASCs strained an already struggling healthcare were co-located with hospitals, pasystem. So while technological advance- tients who experienced potentially ments have allowed procedures such as catastrophic complications from a gallbladder removal and hernia repair procedure would be much closer to to move away from overnight hospital emergency room care that could save stays and into a less costly outpatient lives. setting, if the number of procedures “If there were an emergency, it’s a lot being performed increases too much, faster and easier to rush a patient across the result is still a net gain in overall the parking lot to the emergency room, healthcare costs. as opposed to rushing them across town,” Drazen says. “Those kinds of serious WHAT HOSPITALS CAN DO ABOUT IT complications might not happen very “Although hospitals have been aware that often, but when they do, the time saved physician-owned ASCs have been siphon- could mean the di erence between life ing o some of their business for quite some and death.” MHE time, there just wasn’t much they could do about it,” Drazen says. “Fighting with the FOR MORE INSIGHT physicians who admit patients to their hosSee more Hospitals and Providers pital isn’t a tenable position for them.” managedhealthcareexecutive.com ments in high-resolution imaging technologies. Doctors’ ability to diagnose and treat health conditions has been boosted tremendously by magnetic resonance imaging and computed topography scans, but at a cost—literally. http://www.managedhealthcareexecutive.com
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