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5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
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5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011

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  • 1. Ambulatory Surgery Centers in the United States of America David Shapiro, MDNational Conference on Ambulatory Surgery Bangalore
  • 2. Dr. David Shapiro Physician Anesthesiologist (Specialization in Outpatient Anesthesia) Florida Society of ASCs (FSASC) : Board Member ASC Association (ASCA) : Chairman of the Board ASC Quality Collaboration : Co -Chair AAAHC : Surveyor AORN ASC Administrator Course : Faculty Certified Administrator Surgery Center (CASC) by the Board of Ambulatory Surgery Certification Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance & Utilization Review Physicians Certified in Healthcare Compliance (CHC) by the American Hospital Association Certified Professional in Healthcare Risk Management (CPHRM) by the Health Care Compliance Board Licensed in Healthcare Risk Management (LHRM) by the State of Florida
  • 3. History of ASCs in the United StatesOpened February 12, 1970 in Phoenix, ArizonaFounded by Wally Reed, MD John Ford, MDNamed “Surgicenter”Originally 4 ORsNow 6 ORs, 4 Endoscopy Suites
  • 4. First sketch of Surgicentermade on the back of a tenttable ad at Smuggler’s Innin Chicago in 1968.
  • 5. John L. Ford, MD and Wally Reed, MD in the OR on Surgicenter’s opening day, February 12, 1970.
  • 6. ASC TimelineWallace Reed, MD, and JohnFord, MD, commit their idea fora freestanding ambulatorysurgery facility to paper for thefirst time and developobjectives for the facility. They The Society of Freestandingbegin collecting endorsements Ambulatory Surgical Carefrom the governmental bodies (ASCA’s original name) isand members of the health incorporated during an ASCcare community to obtain seminar conducted infinancing for the project. Phoenix, Arizona. 1970 1975-1976 1968 1974 Reed and Ford’s idea becomes Rapid growth. A total of 42 reality when on February 12 surgery centers are in Surgicenter, the nation’s first operation in the US by 1975 freestanding ambulatory and an additional 25 surgery facility, opens for facilities open in 1976. business. Five physicians perform five procedures at the facility that day, four requiring general anesthesia.
  • 7. ASC TimelineThe industry continues togrow, with the number ofASCs reaching triple digits.ASCA and others join together Medicare modifies the ASCto form the Accreditation list to use specific CPT codesAssociation for Ambulatory and expands the list toHealth Care (AAAHC). include 1,535 procedures. 1982 1988 1979 1987 Medicare approves payment The number of ASCs in the to ASCs for approximately 200 US reaches 1,000. Using the procedures, which are placed information from a 1986 in one of four payment groups cost survey of ASCs, with payment rates between Medicare implements a new $231 and $336, based upon a payment system, which cost survey of 40 ASCs. remains the basis for ASC payments today.
  • 8. ASC TimelineASCs go international whenthe International Associationfor Ambulatory Surgery More than 5,300 ASCs exist(IAAS) is founded during the in the US today, performing1st International Congress on 23 million surgeriesAmbulatory Surgery in annually. Medicare hasBrussels. Medicare expands granted approval for ASCsthe ASC list to cover more to perform more thanthan 2,000 procedures. 3,500 procedures. 2002 1995 2011 Seventy-eight individuals earn the CASC credential, the first- ever ASC-specific credential, establishing the ASC administrator as a separate and distinct career from other health care management and clinical positions.
  • 9. Number of ASCs Per State
  • 10. Number of ASCs Per Capita (Top Ten) ASCs per State Population ASCs 100,000 PeopleMaryland 5,773,552.00 354 6.13Wyoming 563,626.00 19 3.37Washington 6,724,540.00 220 3.27Idaho 1,567,582.00 51 3.25Georgia 9,687,653.00 287 2.96Delaware 897,934.00 24 2.67New Jersey 8,791,894.00 233 2.65Nebraska 1,826,341.00 47 2.57Arizona 6,392,017.00 152 2.38Tennessee 6,346,105.00 149 2.35
  • 11. Surgical Trends
  • 12. Surgical Trends
  • 13. Specialties Served in ASCs by Claims 2,000 1,971,000 1,802,000 31.1% 28.4% 1,800 1,600 1,384,000 21.8% 1,400In Thousands of Dollars 1,200 1,000 800 508,000 600 8.0% 278,000 400 4.4% 209,000 76,000 74,000 3.3% 200 1.2% 14,000 1.2% 3,000 23,000 0.2% 0.0% 0.4% 0
  • 14. Specialties Served in ASCs by Reimbursement $1,400 $1,416 42.4% $1,200 $1,000In Millions of Dollars $800 $627 18.8% $600 $463 $407 13.9% 12.2% $400 $120 $134 $200 3.6% $68 $59 4.0% $30 2.0% $15 1.8% $1 0.9% 0.4% 0.0% $0
  • 15. ASC Ownership Corp-Hosp-Phys, Corporate, 6% 2% Hospital, 2% Hosp-Phys, 17% Corp-Phys, 8% Physician, 65%*Note: The Corporate-Hospital category had 0% ownership in the survey results.
  • 16. ASC Ownership Trends Physician Other 2009 92% 8% 2008 90% 10% 2007 91% 9% 2006 91% 9% 2005 91% 9% 2004 90% 10% 2009 2008 2007 2006 2005 2004 PHYSICIAN 62% 63% 61% 61% 63% 61% CORPORATE 6% 7% 7% 7% 5% 7% HOSPITAL 2% 2% 2% 3% 3% 3% CORP-PHYS 9% 10% 10% 11% 10% 11% CORP-HOSP 0% 0% 0% 0% 0% 0% HOSP-PHYS 17% 16% 17% 16% 16% 16%CORP-HOSP-PHYS 3% 2% 2% 3% 2% 2%
  • 17. ASC Regulation• Federal Regulation Center for Medicare & Medicaid Services (CMS)• State Regulation Various State Health Department and/or Agencies• Local Regulation Primarily Building and Fire Code Compliance Enforcement
  • 18. CMS: Definition of an ASCEffective May 18, 2009 - “means any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission.” 42 CFR 416.2 DEFINITIONS
  • 19. CMS• Defines ASCs in Federal Law• Determines Payment Policies – Allowable Procedures – Applicable Rates – Annual Updates• Determines ASC’s Participation in Federal Programs – Conditions of Coverage -Infection Control Checklist• Administer Quality Reporting Programs
  • 20. ASC AccreditationASCs are Accredited by 4 different Organizations: Accreditation Association for Ambulatory Health Care (~3,010) Joint Commission (~637) American Association for Accreditation of Ambulatory Surgical Facilities American Osteopathic AssociationAs of Spring 2011: Over 70% of ASC facilities in the U.S. are accredited by one of these four organizations
  • 21. Top Ten Procedures by Volume HCPCS 2010 Specialty Short Descriptor Code VolumeOphthalmology 66984 1,123,252 Cataract surg w/iol 1 stageGastrointestinal 43239 516,603 Upper gi endoscopy biopsyGastrointestinal 45380 358,733 Colonoscopy and biopsyGastrointestinal 45385 275,898 Lesion removal colonoscopyGastrointestinal 45378 271,762 Diagnostic colonoscopyOphthalmology 66821 256,749 After cataract laser surgeryPain Management 64483 245,274 Inj foramen epidural l/sPain Management 62311 229,492 Inject spine l/s (cd)Pain Management 64494 191,097 Inj paravertebral facet jointPain Management 64484 128,510 Inj foramen epidural add-on
  • 22. Reimbursement: Most Highly Paid Procedures HCPCS Final CY 2011 Short Descriptor Code ASC Payment 69930 Implant cochlear device $29,056.15 33249 Implant pacemaker leads $25,360.04 33240 Insert pulse generator $22,212.75 64568 Neurostimulator implantation $21,333.84 61886 Placement cr. neurostimulator $17,849.58 61885 Insertion /redo neurostimulator $13,816.04 63685 Insertion/redo spinal stimulator $13,816.04 64590 Insertion/redo gastric stimulator $13,816.04 62361 Implant spine infusion pump $12,221.29 62362 Implant spine infusion pump $12,221.29
  • 23. Operational Data ASCA Outcomes Monitoring ProjectBusiness Operations (#4) Net Charges Days in A/R Outstanding Paid Clinical Non-Physician HoursClinical Operations (#19) On Time Rate Operating Room Time Cancellation RateClinical Outcomes (#19) Cardiac/Respiratory Arrest Nausea / Vomiting Retained Foreign Object
  • 24. ASC Quality Collaboration• Funded by ASCA & ASC companies• Outcomes reporting• Outcomes measure development• Sharing best practices• Clinical studies• Promoting transparency
  • 25. Quality Data Reporting Six NQF Endorsed Measures• Patient Burn• Patient Fall• Wrong Site, Side, Patient, Procedure or Implant• Hospital Transfer / Admission• Prophylactic Intravenous Antibiotic Timing• Appropriate Method of Hair Removal
  • 26. Current Trends Physician Employment MDs per ASC70 7060 6050 5040 4030 3020 2010 10 0 0 2002 2003 2004 2005 2006 2007 2008 2009 1990 1995 2000 2005 2010E Unemployment High Deductible Plans10 30 9 8 25 7 20 6 5 15 4 3 10 2 5 1 0 0 2005 2007 2009 2011 2013 2015 2006 2007 2008 2009 2010
  • 27. Impact Growth in Growth in Outpatient Surgery Number of ASCs 12 12Year-over-Year % Change Year-over-Year % Change 10 8 8 4 6 0 4 -4 2 -8 0 1998 2000 2002 2004 2006 2008 2010 1998 2000 2002 2004 2006 2008 2010
  • 28. ASC FutureASCs: The Innovative Solution for Health Care Access Convenience Provision of Critical Services Cost Efficiency Transparency Quality Clinical Outcomes Patient Satisfaction
  • 29. Ambulatory Surgery Centers in the United States of America David Shapiro, MDNational Conference on Ambulatory Surgery Bangalore

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