Two physicians opened the first ambulatory surgical center (ASC) in 1970 in Phoenix, Arizona to create a workplace where they could call the shots. For the first time, physicians were in control of everything from scheduling to the types of medical equipment purchased.
While many ASCs remain independent (100 percent physician-owned) like the very first one, the intense market demand for care outside of the hospital setting has led to an influx in corporate investment and co-ownership of practices. Still, today, more than 5,800 ASCs exist all over the country, providing economic and convenience benefits to providers and patients alike for same-day surgical procedures.
“Over the last several years, it’s become apparent that the hospital setting just isn’t the most appropriate for a lot of surgical and procedural care,” according to Dr. Michael Owens, a gastroenterologist in Portland, Oregon. “Patients, health systems, and payers are all looking to the ASC now for mutual benefit.”
ASCs offer a plethora of procedures today, ranging from orthopedic surgery to endoscopy. According to March 2022 data from the U.S. Centers for Medicare & Medicaid Services (CMS), 32 percent of single specialty ASCs, or EASCs, perform endoscopies – upper endoscopy, colonoscopy, etc. – and 37 percent of multispecialty centers offer endoscopy services.
“EASCs fit well for everyone in this healthcare scenario,” according to a study in Clinics and Colon and Rectal Surgery. “They are more efficient than hospital-based procedures, they are less costly to payers than hospital-based procedures, and they provide an additional source of revenue to healthcare providers.”
Pros and Cons of Physician Ownership
For providers with a full or partial stake in ASC ownership, the benefits extend beyond those offered owners of any profitable business, according to Owens. Physicians also have the chance to offer greater value-based care, he said.
For physicians with any stake in outpatient service ownership, benefits for them and their patients include:
Eliminating the need for negotiations over types of medical equipment used.
Controlling scheduling and offering greater flexibility for patients.
“ASCs are typically nimbler, faster to react to change and may therefore have the ability to embrace new methods, technology and policies,” Owens said. “But this is not always the case, a poorly run ASC might be more disadvantaged than other sites of service.”
Having a good business partner can be crucial to success, Owens said, but it is not imperative for physicians to have a business administrative background to put the needs of their patients first and run a successful practice.
“We are professionals who do understand the delivery of health care as experts, and I’d encourage my colleagues to want more seats at the table,” he said.
https://www.endosound.com/wp-content/uploads/2022/12/ASCs-the-Benefits-of-Physician-Ownership-.jpg365835KG-Endosoundhttp://www.endosound.com/wp-content/uploads/2023/08/Endosound-New-web-logo-no-tag2023.pngKG-Endosound2022-12-07 16:33:482022-12-08 13:16:56ASCs, the Benefits of Physician Ownership
There are many factors to consider when deciding where to seek care for patients needing a routine or advanced endoscopic procedure. Perhaps it’s urgency for diagnostic or therapeutic care, the ability to travel, a desired physician to see, the convenience of available appointment times, or simply going to the first place found on Google.
But one influence is increasingly difficult to ignore: the bill.
Depending on type of coverage and whether benefits are from private or public sources, patients may unknowingly be directed to select certain locations for care. Increasingly, payors are favoring ambulatory service centers (ASCs) as a cost-effective alternative to hospitals.
“The ASC is usually more efficient, and the patient will benefit by having specialized care in a more efficient manner,” according to Dr. Adam Goodman, a gastroenterologist and professor at NYU Langone Hospital-Brooklyn. “The system benefits by less administrative costs, greater efficiency, and more procedures getting done in a similar amount of time.”
Ultimately, patients receive the same quality of care, but at a much-reduced cost, Goodman said.
It is estimated today that 90 percent of colonoscopies are performed in ASCs, hospital outpatient clinics, or in physician’s offices. Up to 32 percent of the ASC’s in the U.S. specialize in endoscopy alone, while 37 percent of the multi-specialty centers offer endoscopy services, including upper GI endoscopy, sigmoidoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS).
Since ASCs typically offer specialized care, procedures can usually be performed more efficiently and quickly than at hospitals, resulting in lower costs. Patients seeking care at ASCs are likely also to have fewer complex conditions, requiring fewer resources for care. A recent study in California found colonoscopies cost an average $2,300 less when performed at an ASC rather than a hospital.
In fact, large payors have increasingly created policies that favor ASC care and may put continued pressure on physicians to perform non-urgent procedures in these settings. In some instances, insurance companies won’t pay for a routine colonoscopy in the hospital anymore. For example, United Healthcare now restricts sites available for non-emergent surgeries and Empire Blue Cross Blue Shield in New York began requiring proof of medical necessity for certain procedures to be performed outside of an ASC in 2021. The New York-based company argued procedures they were pushing to ASCs have been safely provided in such settings for many years. This is particularly true for GI endoscopy.
Studies have shown how care provided at ASCs is significantly cheaper than hospitals – with one report from Regent Surgical Health estimating healthcare cost savings up to $38 billion annually. Additionally, combined out-of-pocket expenses for patients could be reduced by roughly $5 million annually, according to the report. Even for advanced GI endoscopy procedures like ERCP or EUS, ASCs can offer a cost-effective alternative to a hospital.
ASCs are becoming increasingly popular throughout the country, and there are more than 5,000 operating nationwide today. If payors continue to drive future care to the centers, that number will only grow.
https://www.endosound.com/wp-content/uploads/2022/11/The-Role-Payors-Play-in-Where-Patients-Seek-Care.jpg365835KG-Endosoundhttp://www.endosound.com/wp-content/uploads/2023/08/Endosound-New-web-logo-no-tag2023.pngKG-Endosound2022-11-01 17:26:562022-11-01 17:26:56The Role Payors Play in Where Patients Seek Care
The first experimental endoscopies were performed on sword swallowers – those who had the skills to allow long tubes down their throats without causing harm to their bodies. Today, no such patient skills are required to undergo an endoscopy, thankfully. And with advancements in imaging technology, patients can wake up to view images directly from their digestive tract, lungs, urinary tract or uterus even immediately after their procedure.
Millions of patients undergo endoscopic procedures every year in the U.S. This minimally invasive option for treatment that sends long, thin tubes into hollow cavities of the body for diagnostic and therapeutic procedures. Several hundred years since those early sword swallowing days, those tubes can even facilitate ultrasound imaging.
Endoscopic ultrasound (EUS) has become increasingly attractive to patients and physicians. For gastroenterologists, these procedures allow physicians to diagnose severe digestive illnesses more efficiently. GI EUS is used to diagnose and evaluate a variety of conditions, including:
Mediastinal diseases
Pancreatic cysts and masses
Anorectal pathology
Subepithelial gastrointestinal lesions
Dr. Stephen Steinberg, co-founder and president of EndoSound, describes EUS as an incremental skill, meaning endoscopists don’t need to have mastered every advanced technique of the procedure in order to offer the benefits of EUS to their patients. There is still much to be gained from a “basic” EUS procedure, that could save patients time and money from having to travel to other medical centers for the kind of attention they need.
For example, EUS can provide endoscopists with more information than other imaging tests and evaluate lumps or lesions previously detected in other endoscopies. The ultrasound images can inform the origin of abnormalities and help inform treatment decisions. The procedure has proven successful in helping physicians diagnose diseases that couldn’t be confirmed with other testing options.
“While exciting diagnostic and therapeutic advances hold our attention, it may be important to highlight the one trend that could be the most important for patients – the increasing integration of EUS into general gastrointestinal (GI) training and practice,” wrote Anand V Sahai, in his 2018 Endoscopic Ultrasound journal article, “EUS is Trending!”
But, since EUS competency requires additional training, “it remains limited to a selected group of physicians willing to make this extra sacrifice, to allow them to include EUS in their GI practice,” according to Sahai’s article.
Challenges remain all over the world in establishing EUS in routine practice. These include the required physician competency and upfront equipment costs, specialized endoscopes, and accessories for EUS-guided fine-needle aspiration or EUS-guided fine-needle biopsy.
GI endoscopists need to complete close to 400 EUS procedures addressing multiple areas (mucosal tumors, pancreaticobiliary, etc.) over the course of 24 months to have full competency in EUS, according to guidance from the American Society for Gastrointestinal Endoscopy (ASGE). Training programs, even post-fellowship opportunities through the ASGE, are available and often at capacity. U.S. physicians may also find training opportunities abroad, where there are fewer restrictions for visiting endoscopists to perform procedures.
The benefits to seeking that additional training go beyond those for the patient and can outweigh time and revenue lost during training and acquiring necessary tools. If patients can undergo EUS at their local hospital or ambulatory surgery center (ASC), they can benefit from an advanced procedure that can assess damage to the digestive system, assist in diagnosing cancers, or potentially receive therapeutic procedures like cyst drainage, all without the added stress of travel to large medical centers were EUS is typically performed. For those that can receive EUS in an ASC, they avoid a potentially unnecessary hospital stay and may find more affordable care.
So, even for well-established GI endoscopists several years removed from fellowship training, pursuing mid-career training in EUS could open more possibilities for treatment and care in facilities and practice. There are initial steps, including time needed for training and upfront equipment costs, but the rewards for quality of care provided to patients just may be worth it in expanding a growing practice.
http://www.endosound.com/wp-content/uploads/2023/08/Endosound-New-web-logo-no-tag2023.png00KG-Endosoundhttp://www.endosound.com/wp-content/uploads/2023/08/Endosound-New-web-logo-no-tag2023.pngKG-Endosound2022-09-02 09:21:132022-09-07 09:58:13Adding EUS to your practice. What are the benefits?
ASCs, the Benefits of Physician Ownership
ASCs, Industry NewsTwo physicians opened the first ambulatory surgical center (ASC) in 1970 in Phoenix, Arizona to create a workplace where they could call the shots. For the first time, physicians were in control of everything from scheduling to the types of medical equipment purchased.
While many ASCs remain independent (100 percent physician-owned) like the very first one, the intense market demand for care outside of the hospital setting has led to an influx in corporate investment and co-ownership of practices. Still, today, more than 5,800 ASCs exist all over the country, providing economic and convenience benefits to providers and patients alike for same-day surgical procedures.
“Over the last several years, it’s become apparent that the hospital setting just isn’t the most appropriate for a lot of surgical and procedural care,” according to Dr. Michael Owens, a gastroenterologist in Portland, Oregon. “Patients, health systems, and payers are all looking to the ASC now for mutual benefit.”
ASCs offer a plethora of procedures today, ranging from orthopedic surgery to endoscopy. According to March 2022 data from the U.S. Centers for Medicare & Medicaid Services (CMS), 32 percent of single specialty ASCs, or EASCs, perform endoscopies – upper endoscopy, colonoscopy, etc. – and 37 percent of multispecialty centers offer endoscopy services.
“EASCs fit well for everyone in this healthcare scenario,” according to a study in Clinics and Colon and Rectal Surgery. “They are more efficient than hospital-based procedures, they are less costly to payers than hospital-based procedures, and they provide an additional source of revenue to healthcare providers.”
Pros and Cons of Physician Ownership
For providers with a full or partial stake in ASC ownership, the benefits extend beyond those offered owners of any profitable business, according to Owens. Physicians also have the chance to offer greater value-based care, he said.
For physicians with any stake in outpatient service ownership, benefits for them and their patients include:
“ASCs are typically nimbler, faster to react to change and may therefore have the ability to embrace new methods, technology and policies,” Owens said. “But this is not always the case, a poorly run ASC might be more disadvantaged than other sites of service.”
Having a good business partner can be crucial to success, Owens said, but it is not imperative for physicians to have a business administrative background to put the needs of their patients first and run a successful practice.
“We are professionals who do understand the delivery of health care as experts, and I’d encourage my colleagues to want more seats at the table,” he said.
The Role Payors Play in Where Patients Seek Care
ASCs, Industry News, Updates in GIThere are many factors to consider when deciding where to seek care for patients needing a routine or advanced endoscopic procedure. Perhaps it’s urgency for diagnostic or therapeutic care, the ability to travel, a desired physician to see, the convenience of available appointment times, or simply going to the first place found on Google.
But one influence is increasingly difficult to ignore: the bill.
Depending on type of coverage and whether benefits are from private or public sources, patients may unknowingly be directed to select certain locations for care. Increasingly, payors are favoring ambulatory service centers (ASCs) as a cost-effective alternative to hospitals.
“The ASC is usually more efficient, and the patient will benefit by having specialized care in a more efficient manner,” according to Dr. Adam Goodman, a gastroenterologist and professor at NYU Langone Hospital-Brooklyn. “The system benefits by less administrative costs, greater efficiency, and more procedures getting done in a similar amount of time.”
Ultimately, patients receive the same quality of care, but at a much-reduced cost, Goodman said.
It is estimated today that 90 percent of colonoscopies are performed in ASCs, hospital outpatient clinics, or in physician’s offices. Up to 32 percent of the ASC’s in the U.S. specialize in endoscopy alone, while 37 percent of the multi-specialty centers offer endoscopy services, including upper GI endoscopy, sigmoidoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS).
Since ASCs typically offer specialized care, procedures can usually be performed more efficiently and quickly than at hospitals, resulting in lower costs. Patients seeking care at ASCs are likely also to have fewer complex conditions, requiring fewer resources for care. A recent study in California found colonoscopies cost an average $2,300 less when performed at an ASC rather than a hospital.
In fact, large payors have increasingly created policies that favor ASC care and may put continued pressure on physicians to perform non-urgent procedures in these settings. In some instances, insurance companies won’t pay for a routine colonoscopy in the hospital anymore. For example, United Healthcare now restricts sites available for non-emergent surgeries and Empire Blue Cross Blue Shield in New York began requiring proof of medical necessity for certain procedures to be performed outside of an ASC in 2021. The New York-based company argued procedures they were pushing to ASCs have been safely provided in such settings for many years. This is particularly true for GI endoscopy.
Studies have shown how care provided at ASCs is significantly cheaper than hospitals – with one report from Regent Surgical Health estimating healthcare cost savings up to $38 billion annually. Additionally, combined out-of-pocket expenses for patients could be reduced by roughly $5 million annually, according to the report. Even for advanced GI endoscopy procedures like ERCP or EUS, ASCs can offer a cost-effective alternative to a hospital.
ASCs are becoming increasingly popular throughout the country, and there are more than 5,000 operating nationwide today. If payors continue to drive future care to the centers, that number will only grow.
Adding EUS to your practice. What are the benefits?
General News, Industry News, Updates in GIThe first experimental endoscopies were performed on sword swallowers – those who had the skills to allow long tubes down their throats without causing harm to their bodies. Today, no such patient skills are required to undergo an endoscopy, thankfully. And with advancements in imaging technology, patients can wake up to view images directly from their digestive tract, lungs, urinary tract or uterus even immediately after their procedure.
Millions of patients undergo endoscopic procedures every year in the U.S. This minimally invasive option for treatment that sends long, thin tubes into hollow cavities of the body for diagnostic and therapeutic procedures. Several hundred years since those early sword swallowing days, those tubes can even facilitate ultrasound imaging.
Endoscopic ultrasound (EUS) has become increasingly attractive to patients and physicians. For gastroenterologists, these procedures allow physicians to diagnose severe digestive illnesses more efficiently. GI EUS is used to diagnose and evaluate a variety of conditions, including:
Dr. Stephen Steinberg, co-founder and president of EndoSound, describes EUS as an incremental skill, meaning endoscopists don’t need to have mastered every advanced technique of the procedure in order to offer the benefits of EUS to their patients. There is still much to be gained from a “basic” EUS procedure, that could save patients time and money from having to travel to other medical centers for the kind of attention they need.
For example, EUS can provide endoscopists with more information than other imaging tests and evaluate lumps or lesions previously detected in other endoscopies. The ultrasound images can inform the origin of abnormalities and help inform treatment decisions. The procedure has proven successful in helping physicians diagnose diseases that couldn’t be confirmed with other testing options.
“While exciting diagnostic and therapeutic advances hold our attention, it may be important to highlight the one trend that could be the most important for patients – the increasing integration of EUS into general gastrointestinal (GI) training and practice,” wrote Anand V Sahai, in his 2018 Endoscopic Ultrasound journal article, “EUS is Trending!”
But, since EUS competency requires additional training, “it remains limited to a selected group of physicians willing to make this extra sacrifice, to allow them to include EUS in their GI practice,” according to Sahai’s article.
Challenges remain all over the world in establishing EUS in routine practice. These include the required physician competency and upfront equipment costs, specialized endoscopes, and accessories for EUS-guided fine-needle aspiration or EUS-guided fine-needle biopsy.
GI endoscopists need to complete close to 400 EUS procedures addressing multiple areas (mucosal tumors, pancreaticobiliary, etc.) over the course of 24 months to have full competency in EUS, according to guidance from the American Society for Gastrointestinal Endoscopy (ASGE). Training programs, even post-fellowship opportunities through the ASGE, are available and often at capacity. U.S. physicians may also find training opportunities abroad, where there are fewer restrictions for visiting endoscopists to perform procedures.
The benefits to seeking that additional training go beyond those for the patient and can outweigh time and revenue lost during training and acquiring necessary tools. If patients can undergo EUS at their local hospital or ambulatory surgery center (ASC), they can benefit from an advanced procedure that can assess damage to the digestive system, assist in diagnosing cancers, or potentially receive therapeutic procedures like cyst drainage, all without the added stress of travel to large medical centers were EUS is typically performed. For those that can receive EUS in an ASC, they avoid a potentially unnecessary hospital stay and may find more affordable care.
So, even for well-established GI endoscopists several years removed from fellowship training, pursuing mid-career training in EUS could open more possibilities for treatment and care in facilities and practice. There are initial steps, including time needed for training and upfront equipment costs, but the rewards for quality of care provided to patients just may be worth it in expanding a growing practice.