Can your hospital survive the growing dominance of ASCs?
Surgeons have multiple options of where theyre going to do surgery, hospitals are competing for that volume. And with the emergence of the ASCs, I mean, if youre not efficient, theres a lot of leakage thats happening. But how do you do that? You need to look at how youre using your OR today in a thoughtful way and align it to the surgeon practice patterns. Go there have a conversation with your surgeons. There are so many times that Ive gone to a surgeons clinic, had a conversation with their clinic manager, and theyll tell me, Well, were hiring another surgeon in September. And I go back to the hospital, Did you know that? Theyre like, No. And Im like, well, how do you anticipate that youre going to support this new surgeon theyre going to bring on board?
If the surgeon has better access at the ASC, thats where the surgeon is doing the surgeries. There are certain places that Ive seen where the ASC is so busy that the surgeon wants to come back to the hospital because theyre so backlogged. Thats because the ASC so busy. Once they open up more rooms, whats that surgeon going to do? This whole world about how we manage that access. So we can find a way to decompress them. Is going to be critical but the challenge here, and lets be transparent, is if youre a hospital and you have– youre growing in your inpatient volume, youre backlog with inpatient beds, you have your length of stay creeping up to like three four days whatever may be. Your capacity constraints is the resources you have to do surgical cases and your bed capacity.
Lets say youre an employed physician, youre an employed physician and you do your surgery at the ASC, well, I as a hospital– and it depends on the relationship with that ASC but just imagine that ASC now were 50% owners with the physicians. So the hospital takes that procedure, does it at the ASC now theyre losing 50% of the revenue, but theyre losing 50% of a discounted revenue. So instead of making $100 youre only making $40, and now were only getting 50% of that 40 bucks. So now Im only getting 20 instead of 100 by doing that case in the ASC. You want to partner with the private surgeons who are out there growing in the ASC market, align incentives.
If the volume is going there then anticipate its going there and accept reality, its not coming back. Partner with these physicians, grow into the ASC space, particularly, these private surgeons who are only focusing on commercial insurance. The cost of your care there is reduced, your margin is actually higher, and youre splitting more, and your production is much greater in that space with those private surgeons. I would say with your employed surgeons, what you really want to do is look at value based care contracts. So that way Im getting a bundled payment to do a total knee.
Regardless of where I do it Im getting this reimbursement. And then the surgeons going to say, This patient should be done ASC, this patient needs to be done in a hospital because we anticipate an inpatient stay. When you can do it internally, lets help you figure out that foundation so that way you can go out and partner with these private surgeons in a way thats meaningful.