Last week about 80 executives from ambulatory surgical centers, along with companies that support their work, met in North San Diego, CA for the ASC 100 Executive Management Conference. The event covered policy issues, quality measures, managed care topics, and financial challenges for about 5,000 U.S. outpatient centers.

Like many health care sectors, executives at ambulatory surgical centers await health care policy reform in Washington and its potential sweeping changes to service delivery in all practice settings. A policy briefing at the conference featured lobbyist Marshall Brachman and Robert Wood, President of the BGR Group LLC.

"This year kicked off with a bang," Wood said. "Januarys are supposed to be quiet in Washington." He outlined political activities and key players, noting that it's been 30 years since the Democrats have enjoyed a working majority. "This is the year for health care reform," he said.

But what form will reform take? Will it be insurer based, patient based or other? Public, private or a combination? We should know soon since the plan is on an aggressive schedule, despite the setback of the dashed Daschle nomination.

"Champions matter in Washington," Wood said noting the big difference that a single legislator or policy person can make.

Challenges for Ambulatory Surgical Centers

The key issue for ASCs is a concern that their practice model, many physician owned, has gotten bad press lately and is becoming the focus of greater regulatory scrutiny and lower reimbursements.

"A mantra in Washington is 'overutilization,'" Brachman cautioned. "Clinical appropriateness is questioned when doctors own businesses, practices and equipment." He noted that hospitals are regarded as a safety net and to some degree, surgical centers represent competition. ASCs are reimbursed far less than hospitals in this dynamic in which regulators want to preserve larger institutions and community hospitals.

Brachman and Wood detailed a fragmented legislative approach in which provisions related to ASCs were contained in several unrelated proposals.

Other big questions for ASCs reflect those of the broader health care community and surround the role of government in health care and the impact of comparative effectiveness research on therapies and technologies.

Wood noted that ASC operating principles may serve the centers well in the long term because of their blend of quality care and cost-effectiveness. These principles include value-based purchasing, quality performance and reporting, and the effort to put the patient in the right setting for the procedure in question.

Brachman added, "The 5,000 ambulatory surgical centers in the U.S. save money and provide great care."

For the moment, businesses and the health care community are expressing an interest in working together on reform, the experts concluded about the climate in Washington.

Also read our coverage of the concurrent Imaging 100 meeting at https://www.dotmed.com/news/story/8653 and watch DOTmed News for ongoing coverage of ambulatory surgical centers and diagnostic imaging centers.

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