beginning of the end for the profitable ASC's?

[militarymd]

Look what CMS is doing for 2008.

Where CMS goes, Blue Cross follows.

Zippy....enjoy your ride now, I suspect in the near future (ie before i retire) many profitable ASCs will become "struggling" ASC's as the drive to send patients there ($$$$$) is shifted to regular full service hosptals.

Our specialty has always remained out of this fight because we have also benefitted from the free standing ASC's....but for guys like me who are hospital based, this will likely make our practices more profitable.

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[UTSouthwestern]

Look what CMS is doing for 2008.

Where CMS goes, Blue Cross follows.

Zippy....enjoy your ride now, I suspect in the near future (ie before i retire) many profitable ASCs will become "struggling" ASC's as the drive to send patients there ($$$$$) is shifted to regular full service hosptals.

Our specialty has always remained out of this fight because we have also benefitted from the free standing ASC's....but for guys like me who are hospital based, this will likely make our practices more profitable.

Well you finally decide to show up here again. Merry Christmas you bum.

Yes, the beginning of the end may be near. The AAASC and other organizations affiliated with ASC's feel this will be a big blow to their paycheck. To offset this this possibility, those facilities with enough equipment, facilities, and staff are preparing for the possibility that they will have to add ICU facilities, overnight staff, etc. to accomodate the requisition for long term facilities to perform certain cases. That conversion however, places the ASC under a new set of regulations of which you are probably more than familiar with.

Smaller ASC's without this capacity are likely to feel the heat and either convert their focus to single profitable specialties or focus on cash paying patient bases, which are historically unreliable for supporting ASC profitability.

One clue I received is that a good friend of mine in San Antonio who is an anesthesiologist and co-owns 2 ASC's with 4 surgeons has put them both up for sale despite their current tremendous profitability. It is a buyer beware market with a lot of investment people ignoring the future trend.

 

[militarymd]

Merry Christmas to you too!!

 

[coprolalia]

Okay, help a lowly resident out here. What are you guys talking about? Can you give us a little more of a background?

-copro

 

[Sevo]

Okay, help a lowly resident out here. What are you guys talking about? Can you give us a little more of a background?

-copro

Effective January 1st (to be phased in over a year), Medicare will start paying a lot less to ambulatory surgical centers. In general, they will be reimburing surgery centers 40% less than what they would pay a hospital if the procedure had been done at a hospital's outpatient facility (or if the patient comes in to a hospital as an outpatient).

The ultra-powerful hospital lobby has been pushing for this for years as they've lost a significant amount of income to the proliferation of surgical centers. As per another website: "The goal of the new ASC reimbursement protocol is to coordinate ASC payments with hospital outpatient department payments at a rate which is intended to maintain neutrality between site of service choices. The proposed uniform conversion rate is intended to implement such neutrality."

In general, as MMD alluded, private insurers tend to follow Medicare's lead when it comes to determining fee schedules.

There's also, apparently, a measure working its way through Congress that may force physicians to divest themselves of majority ownership of any surgery center, down to 40%, in order to force "neutrality" down the throats of surgeons that decide to shift their well insured cases to their own facilities.

*** BTW, welcome back, MMD! ****

 

[Sevo]

Look what CMS is doing for 2008.

Where CMS goes, Blue Cross follows.

Zippy....enjoy your ride now, I suspect in the near future (ie before i retire) many profitable ASCs will become "struggling" ASC's as the drive to send patients there ($$$$$) is shifted to regular full service hosptals.

Our specialty has always remained out of this fight because we have also benefitted from the free standing ASC's....but for guys like me who are hospital based, this will likely make our practices more profitable.

As a caveat, there are some specialities that will weather this storm easily. For instance, it appears that our hand surgeons will still continue to make out like bandits at our local "orthopedic hospital" despite the rule change:

http://www.mwe.com/index.cfm/fuseac...t_id/8cc0c68c-571b-4cf3-9b0a-ce476d0a1763.cfm

 

[VentdependenT]

Guess the dude who graduated from Rush last year to work in BF nowhere at a ASC for 400 large, who now lost his skillset, is gonna be pissed. At least in a few years anyways.

 

[coprolalia]

Well, just another way to squeeze and screw both patients and the healthcare providers. Reimbursement goes down, access goes down, quality of care goes down. Sheesh! These *****s just don't get it.

-copro

 

[militarymd]

Well, just another way to squeeze and screw both patients and the healthcare providers. Reimbursement goes down, access goes down, quality of care goes down. Sheesh! These *****s just don't get it.

-copro

I must disagree with you on this one. This is one piece of legistlation that will improve healthcare.

By making full service hospitals more profitable, it will allow the said "full service" hospitals to expand service and coverages which ASC's will never do.

The total money paid out doesn't change. It just shifts it around....out of greedy physician owner's of ASC's pockets into the pockets of hospitals that are governed by boards of trustees.

At least that is the intent.

 

[coprolalia]

I must disagree with you on this one. This is one piece of legistlation that will improve healthcare.

By making full service hospitals more profitable, it will allow the said "full service" hospitals to expand service and coverages which ASC's will never do.

The total money paid out doesn't change. It just shifts it around....out of greedy physician owner's of ASC's pockets into the pockets of hospitals that are governed by boards of trustees.

At least that is the intent.

Interesting perspective. I wonder if the recent "MRSA" getting play in the lay media will have any effect on this. I can't even count the number of patients anymore who are on "contact isolation" when I walk through the wards. It seems like this legislation will essentially force patients to go to the main hospital for outpatient procedures, rife with the risks of contracting one of these bugs... at least in the lay public's minds.

And, I guess my dream of more specialty hospitals and surgicenters will be severely hampered by this.

-copro

 

[Coastie]

Thanks for returning Military...

Look what CMS is doing for 2008.

Where CMS goes, Blue Cross follows.

Zippy....enjoy your ride now, I suspect in the near future (ie before i retire) many profitable ASCs will become "struggling" ASC's as the drive to send patients there ($$$$$) is shifted to regular full service hosptals.

Our specialty has always remained out of this fight because we have also benefitted from the free standing ASC's....but for guys like me who are hospital based, this will likely make our practices more profitable.

 

[cchoukal]

I must disagree with you on this one. This is one piece of legistlation that will improve healthcare.

By making full service hospitals more profitable, it will allow the said "full service" hospitals to expand service and coverages which ASC's will never do.

The total money paid out doesn't change. It just shifts it around....out of greedy physician owner's of ASC's pockets into the pockets of hospitals that are governed by boards of trustees.

At least that is the intent.

Whether shifting money away from "greedy physician owners" to a hospital "board of trustees" is good depends on your perception of the malevolence of the board. At my academic institution, there is a subjective sense that our administration is very top-heavy, laden with MBAs and other execs routinely making more than most of the physicians. I guess I'm a bit too cynical to believe that if hospitals get a larger piece of the pie, that any of it will find its way to real clinical improvements or higher physician salaries.

 

[militarymd]

Whether shifting money away from "greedy physician owners" to a hospital "board of trustees" is good depends on your perception of the malevolence of the board. At my academic institution, there is a subjective sense that our administration is very top-heavy, laden with MBAs and other execs routinely making more than most of the physicians. I guess I'm a bit too cynical to believe that if hospitals get a larger piece of the pie, that any of it will find its way to real clinical improvements or higher physician salaries.

Wait until you get into private practice...you'll see who's greedy.

Academic environments are different from private practice environments.

Physicians in private practice do not receive "salaries" in the sense that residents get paid....

 

[InductionAgent]

Is there any evidence to demonstrate better clinical outcome for the same ambulatory procedure to be done in a hospital vs. an ASC? In the abscence of this, it seems ridiculous to pay more for the procedure to occur in a hospital. On the other hand, if such evidence were available, it would be a different matter.

 

[zippy2u]

So I's got two surgeons with 10 cases each and a 4 room ASC. Both surgeon's start at 0700. We goin' to use all 4 rooms as I got 4 CRNAs. All 4 pts go back to their respective rms at 0630 and the billing begins. Surgeons arrive at 0700 and go to their respective rooms. In the other 2 rooms there is no surgeon but CRNA is with pt and billing time continues. 18 of the 20 pts are gettin' more anesthesia billing time. Now do that 20 times/month and multiply by 12. Watcha got?--COIN! Dammit, ya put up a wall and the sapsuckers are goin' find a way around it. We be just guerrillas in our little guerrilla war.... Regards, ---Zip