Optimism and adaptability key with Medicare changes

Editor's Note

Ambulatory surgery center (ASC) leaders processing the November 21 decision from CMS to finalize its proposal to phase out Medicare’s inpatient-only list are looking at the change with optimism, as well as caution, according to a November 26 news story in Ambulatory Surgery Center News.

The article featured insights from several executives within the ASC market. One expert suggested the change will lead to more complex procedures shifting from inpatient to ASC care and will ease the regulatory due diligence that may be required for ASC mergers and acquisitions. Some procedures likely to make the ASC shift more prominently include cardiovascular ablations such as catheter-based treatments for atrial fibrillation, as well as certain spinal fusions, and several previously inpatient-only spine codes, including more complex decompression and stabilization procedures, one expert described.

Lingering cautions, namely the cost compared to reimbursement for procedures moving from inpatient to ASC care were discussed. One expert noted the likely requirement for increased capital funding, which could add new pressure to ASC partnerships. Meanwhile, payment reductions for specific procedures further intensify that stress, per the article. One important takeaway in the story was the need for ASC leaders to get comfortable with adapting to change, given the ever-changing reimbursement and operational environment. This could include adapting to difficulty with being able to shape a standard 3-5-year strategic plan.