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

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

  1. 1. Ambulatory Surgery Centers in the United States of America David Shapiro, MD National Conference on Ambulatory Surgery Bangalore
  2. 2.  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 Dr. David Shapiro
  3. 3. 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 History of ASCs in the United States
  4. 4. First sketch of Surgicenter made on the back of a tent table ad at Smuggler’s Inn in Chicago in 1968.
  5. 5. John L. Ford, MD and Wally Reed, MD in the OR on Surgicenter’s opening day, February 12, 1970.
  6. 6. ASC Timeline 1968 Wallace Reed, MD, and John Ford, MD, commit their idea for a freestandingambulatory surgery facility to paper for the first time and develop objectivesfor the facility. They begin collecting endorsements from the governmental bodies and members of the health care communityto obtain financingfor the project. 1970 Reed and Ford’s idea becomes reality when on February 12 Surgicenter,the nation’s first freestandingambulatory surgery facility, opens for business.Five physicians perform five procedures at the facility that day, four requiring general anesthesia. 1974 The Society of Freestanding AmbulatorySurgicalCare (ASCA’s original name) is incorporatedduring an ASC seminar conducted in Phoenix, Arizona. 1975-1976 Rapid growth. A total of 42 surgery centers are in operation in the US by 1975 and an additional 25 facilities open in 1976.
  7. 7. 1979 The industry continuesto grow, with the number of ASCs reachingtriple digits. ASCA and others join together to form the Accreditation Association for Ambulatory Health Care (AAAHC). 1982 Medicareapprovespayment to ASCs for approximately200 procedures,which are placed in one of four payment groups with payment rates between $231 and $336, based upon a cost survey of 40 ASCs. 1987 Medicaremodifies the ASC list to use specific CPT codes and expands the list to include1,535 procedures. 1988 The number of ASCs in the US reaches1,000. Using the information from a 1986 cost survey of ASCs, Medicareimplementsa new payment system, which remains the basis for ASC paymentstoday. ASC Timeline
  8. 8. 1995 ASCs go internationalwhen the InternationalAssociation for AmbulatorySurgery (IAAS) is founded during the 1st International Congresson AmbulatorySurgery in Brussels. Medicare expands the ASC list to cover more than 2,000 procedures. 2002 Seventy-eight individualsearn the CASC credential,the first- ever ASC-specific credential, establishingthe ASC administratoras a separate and distinct career from other health care management and clinical positions. 2011 More than 5,300 ASCs exist in the US today, performing 23 million surgeries annually. Medicarehas granted approval for ASCs to perform more than 3,500 procedures. ASC Timeline
  9. 9. Number of ASCs Per State
  10. 10. Number of ASCs Per Capita (Top Ten) State Population ASCs ASCs per 100,000 People Maryland 5,773,552.00 354 6.13 Wyoming 563,626.00 19 3.37 Washington 6,724,540.00 220 3.27 Idaho 1,567,582.00 51 3.25 Georgia 9,687,653.00 287 2.96 Delaware 897,934.00 24 2.67 New Jersey 8,791,894.00 233 2.65 Nebraska 1,826,341.00 47 2.57 Arizona 6,392,017.00 152 2.38 Tennessee 6,346,105.00 149 2.35
  11. 11. Surgical Trends
  12. 12. Surgical Trends
  13. 13. Specialties Served in ASCs by Claims 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000 278,000 4.4% 1,971,000 31.1% 76,000 1.2% 14,000 0.2% 1,802,000 28.4% 508,000 8.0% 74,000 1.2% 1,384,000 21.8% 3,000 0.0% 209,000 3.3% 23,000 0.4% InThousandsofDollars
  14. 14. Specialties Served in ASCs by Reimbursement $0 $200 $400 $600 $800 $1,000 $1,200 $1,400 $120 3.6% $627 18.8% $68 2.0% $15 0.4% $1,416 42.4% $463 13.9% $59 1.8% $407 12.2% $1 0.0% $134 4.0% $30 0.9% InMillionsofDollars
  15. 15. ASC Ownership Corporate, 6% Hospital, 2% Physician, 65% Corp-Phys, 8% Hosp-Phys, 17% Corp-Hosp-Phys, 2% *Note: The Corporate-Hospital category had 0% ownership in the survey results.
  16. 16. ASC Ownership Trends 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% Physician Other 2009 92% 8% 2008 90% 10% 2007 91% 9% 2006 91% 9% 2005 91% 9% 2004 90% 10%
  17. 17. • 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 ASC Regulation
  18. 18. Effective 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 CMS: Definition of an ASC
  19. 19. • 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 CMS
  20. 20. ASC Accreditation ASCs 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 Association As of Spring 2011: Over 70% of ASC facilities in the U.S. are accredited by one of these four organizations
  21. 21. Top Ten Procedures by Volume Specialty HCPCS Code 2010 Volume Short Descriptor Ophthalmology 66984 1,123,252 Cataract surg w/iol 1 stage Gastrointestinal 43239 516,603 Upper gi endoscopy biopsy Gastrointestinal 45380 358,733 Colonoscopy and biopsy Gastrointestinal 45385 275,898 Lesion removal colonoscopy Gastrointestinal 45378 271,762 Diagnostic colonoscopy Ophthalmology 66821 256,749 After cataract laser surgery Pain Management 64483 245,274 Inj foramen epidural l/s Pain Management 62311 229,492 Inject spine l/s (cd) Pain Management 64494 191,097 Inj paravertebral facet joint Pain Management 64484 128,510 Inj foramen epidural add-on
  22. 22. Reimbursement: Most Highly Paid Procedures HCPCS Code Short Descriptor Final CY 2011 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. 23. Operational Data ASCA Outcomes Monitoring Project Business Operations (#4) Net Charges Days in A/R Outstanding Paid Clinical Non-Physician Hours Clinical Operations (#19) On Time Rate Operating Room Time Cancellation Rate Clinical Outcomes (#19) Cardiac/Respiratory Arrest Nausea / Vomiting Retained Foreign Object
  24. 24. ASC Quality Collaboration • Funded by ASCA & ASC companies • Outcomes reporting • Outcomes measure development • Sharing best practices • Clinical studies • Promoting transparency
  25. 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. 26. Current Trends 0 10 20 30 40 50 60 70 20022003200420052006200720082009 Physician Employment 0 10 20 30 40 50 60 70 1990 1995 2000 2005 2010E MDs per ASC 0 1 2 3 4 5 6 7 8 9 10 2005 2007 2009 2011 2013 2015 Unemployment 0 5 10 15 20 25 30 2006 2007 2008 2009 2010 High Deductible Plans
  27. 27. Impact -8 -4 0 4 8 12 1998 2000 2002 2004 2006 2008 2010 Year-over-Year%Change Growth in Outpatient Surgery 0 2 4 6 8 10 12 1998 2000 2002 2004 2006 2008 2010 Year-over-Year%Change Growth in Number of ASCs
  28. 28. ASCs: The Innovative Solution for Health Care Access Convenience Provision of Critical Services Cost Efficiency Transparency Quality Clinical Outcomes Patient Satisfaction ASC Future
  29. 29. Ambulatory Surgery Centers in the United States of America David Shapiro, MD National Conference on Ambulatory Surgery Bangalore

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