Many hospitals and health systems realize they need to develop and implement an ASC plan. 但是,在流程开始时就知道ASC将如何适应您更广泛的组织愿景,将有助于以后做出更好的决策.
This means understanding why your hospital or health system needs an ASC plan to begin with, determining how many ASC ORs and procedure rooms you will need, and understanding the value ASCs will bring to your organization
在考虑ASC战略时,医院高管需要反思以下问题:
- Are your hospital ORs and procedure rooms at capacity or underutilized?
- Has surgery migrated out of the hospital to competing ASCs?
- 通过发展ASC,你会占用医院现有的手术和手术量吗?
- Are your physicians aligned? 您是否因为没有ASCbet8娱乐地点或合作机会而在招募和留住外科bet8网站备用方面遇到困难?
- Have physicians departed because you do not have an ASC?
- Are payers denying benefits to patients who need outpatient surgery that can be performed in an ASC?
- Are payers redirecting your cases to surgeons who have access to an ASC?
- ASC策略是否允许您进入二级市场并创造增值机会?
- 在你们的主要市场中,ASC策略是否需要由于没有回填量而无法替代的滗析手术和程序量
虽然有许多组件将有助于您的ASC计划的成功(参见图1), pursuing the six steps detailed below should set your organization up for success.
FIGURE 1: Key Steps for ASC Development
Step 1: Identify Cases that CAN Migrate
首先进行bet8娱乐地点病例量分析,以评估符合ASC条件并在医院环境中进行的手术和程序病例量. Many factors should be considered, such as the CMS and commercial payer covered procedure lists (CPLs), ASC rules and regulations, patient selection criteria, comorbidities, and market conditions. By identifying the ASC-eligible cases, 您可以继续优化病例的bet8娱乐地点和现有医院资产.
This takes time and is complex, especially without ASC expertise in the planning process. Key considerations and factors beyond the payer-approved CPLs must be factored into the assessment, such as comorbidity factors, length of stay, and access to equipment (e.g., robotics) that may be required to perform the cases. 没有ASC专业知识的医院和bet8网站备用通常与外部主题专家合作,以促进这种分析.
In addition to identifying cases commonly performed in an ASC setting, 前瞻性组织识别并计划未来最有可能在ASC中执行的案例(参见图2).
FIGURE 2: Surgery Migration Trends
Step 2: Identify Cases That SHOULD Migrate
Just because cases are eligible to migrate doesn’t necessarily mean they should. ASC计划流程的这一部分需要确定关键利益相关者和医师支持者,他们将从业务和临床的角度提供意见. For instance, surgeons may not be comfortable performing some procedures in an ASC setting, or there may be limitations to accessing equipment that limit the opportunity for migration. 另一个关键的考虑因素是将有利可图的病例从医院手术室转移到ASC的更广泛的财务影响.
评估符合asc条件的病例首先要进行全面的bet8娱乐地点评估(包括外科bet8网站备用的意见)。. 这将允许组织最终确定将和/或应该迁移到ASC的案例的可行性和财务影响.
Step 3: Engage Payers Early
More often than not, commercial payer contract rates will have a material impact on the financial feasibility of an ASC. So determining the opportunity for reasonable and appropriate reimbursement, and ensuring the ASC has optimal managed care rates, requires payer due diligence and initiating payer discussions early in the ASC development process.
Often, 组织投入时间和金钱来规划他们的新ASC,而没有主动与支付者沟通. Assess opportunities to add ASCs to the hospital or health system commercial payer contracts, and build the business case for reducing the total cost of care. Being proactive with the payer is critical; hospitals and health systems that aren’t soon discover that the rates they receive from payers do not support developing their ASC.
考虑ASC伙伴关系结构以及股权地位和管理控制的某些方面如何影响医院在ASC费率方面与付款人的关系也很重要. 在早期就积极主动地与付款人接触是ASC战略和计划的关键组成部分, and can have material implications on the feasibility of the ASC.
成功的组织在ASC预计开放(或更早)之前9到12个月就为ASC管理医疗合同和战略的成功做好准备。. It is critical the hospital or health system evaluate the implications of migration, develop a business case, and establish a business structure that allows for success with payers.
Step 4: Understand the Financial Impact
制定ASC并了解预计的财务影响不仅仅是确定前期资本需求和预测EBITDA. 许多医院和bet8网站备用犯的一个错误是花时间了解ASC的财务绩效,而不评估其财务影响.
如果没有机会回填病例,将病例从医院转移到ASC将不可避免地影响医院的财务绩效. If the hospital or health system has opportunity to backfill, 重要的是要考虑对付款人组合的影响以及将要执行的取代预期迁移程序的病例类型. This is a critical component of the managed care planning and strategy as well, 还应考虑医院和/或bet8网站备用在ASC合资企业中的股权地位.
Step 5: Develop a Timeline and Work Plan
一个可靠的ASC计划建立在足够的前置时间来执行必要的分析,以进行深思熟虑和做出关键决策, as well as the flexibility to account for unexpected delays. Typically, organizations should plan on the development process taking 12 to 18 months; this is highly dependent on whether the ASC is a buildout of an existing space or if the ASC requires the development of a new building from the ground up.
有许多组件和里程碑可以影响时间表,并最终影响形式和运营工作计划. It is important to account for delays, such as:
- 入住证、州调查和认证/医疗保险调查之间的时间间隔.
- Payer credentialing and contracting.
- Recruitment of an ASC leader and staffing.
Figure 3 provides an example of an ASC development timeline of a de novo ASC, and some important milestones.
FIGURE 3: ASC Development Timeline
Step 6: Embrace and Cultivate an ASC Philosophy
ASC通常比医院运营效率更高的一个原因是ASC的运营理念, culture, and “can do” attitude. When developing your health system’s ASC plan and strategy, 重要的是,这一理念存在于开发的各个阶段,以确保运营效率和卓越性,以及满足并超过ASC标准的护理提供,同时达到高水平的患者, physician, and employee satisfaction. 让ASC专家参与ASC战略的规划和执行阶段,将增加战略成功的可能性.
Stay tuned for our next blog on the key success factors for implementing your ASC plan.
Learn how ECG’s Ambulatory Surgical Care Service and M&A practice teams help clients succeed by applying innovative approaches.
Contact UsEdited by: Matt Maslin
Published August 21, 2023