Hi, everyone. This is Brian Zimmerman with Becker's
Healthcare. Thank you so much for tuning into
the Becker's Healthcare podcast. Today, we're on-site in
Chicago at Becker's thirty first annual meeting, the
business and operations of ASCs,
and we're going to talk about how ambulatory
surgery centers can navigate the evolving regulatory landscape
from state level reforms to federal payment changes
and what these shifts mean for growth, compliance,
and long term strategy.
Joining me for this discussion is Michelle Huntsman,
a partner with Holland and Knight. Michelle, welcome.
Thank you for having me, Brian. I'm very
excited to be here. Yep. To to get
us started here, can you just, I guess,
share with listeners a bit about your background
so they can appreciate your perspective and and
what you're doing now. Absolutely.
So I am a partner at Holland and
Knight in their Houston office.
I was previously with another large law firm
in the Houston area for almost a decade
before joining Holland and Knight this summer.
And my practice focuses it's
on health care m and a and transactional
work. I say I major in transactional work,
and then I have a minor in health
in a health care regulatory practice.
So, we do a significant amount of ASC
joint venture work, syndication work,
and then all of the ancillary compliance work
that comes from the operational side of the
AC industry. For sure. We're definitely gonna pull
tug on some of that expertise here in
just a moment.
Let let's get into it. So, obviously, I
think
big theme at the the conference here right
now and the big theme in general
is just the the rapid pace of change
in the ASC space, thinking from state level
legislative activity to new federal reporting and payment
updates.
From your perspective, what's driving this increased sort
of regulatory momentum around ASCs?
And and what does it signal about the
direction of the sector overall? Where where is
it headed? What's going on? It's a great
question, and it's the million dollar question from
for everyone in the ASC industry right now.
So I think there's there's three factors that
we need to take a look at when
responding to this type of question.
And the first is the undeniable shift to
the outpatient care setting. We're seeing
advances in minimally invasive procedures and just a
general federal protocol that is accelerating migration
of surgeries from the hospital setting to the
outpatient care setting. And the second is just
cost containment. So Medicare sees the value in
shifting procedures from the hospital setting to the
ASC setting. Her autistic assistant the other day
that,
it's estimated the federal government saves about 4,000,000,000
with a b dollars each year
based on the allocation of surgeries
in the ASC setting. So
from that, we're seeing a complete policy modern
modernization push from CMS
where they're really working to put more procedures
on the ASC
covered procedure list. So so generally, what what
this means is is we're watching the ASC
industry mature.
And by mature, I don't mean slow down
in growth. I actually settle into being one
of the pillars of the health care industry,
which
is going to present a whole new set
of issues for all the the actors
and just an exciting time for our industry.
Yeah. There's a lot of excitement there in
terms of becoming a a pillar of and
and the advancement of technology too. It's gonna
be more and more and more procedures are
gonna be able to be in in the
outpatient setting. More care is gonna be able
to deliver there. But there's so much that's
gonna have to change to accommodate that.
Quickly before we move forward, but maybe you
could talk about maybe some of the barriers
that exist even with this regulatory momentum. Like,
what are just gonna stand in the way
of this? Staffing is one that comes to
mind. Like, how are you gonna get
enough physicians migrated out to these facilities in
order to to do that? But just any
other takes on terms of what barriers need
to be knocked down to make that future
a reality. So you're hitting the big one,
right, is is staffing. And then second is
that
we're nationally seeing a
reimbursement
cut. Right? And so Medicare,
the the adjustments Medicare makes to reimbursement
are not in sync with the actual cost
of staffing
and just the general operation of the ASC.
So there's this chasm between
what physicians
are getting paid and then what their costs
are. So that's something we're gonna need to
figure out as an industry is how we
bridge that gap and make these ASCs economically
viable.
We're also seeing private payers take a similar
tactic with reimbursement. So, again, navigating commercial payers
and, working to ensure that the physicians and
ASCs are getting reimbursed for the surgeries.
Yeah. Let let's zero into on sort of,
like, the state what's happening at the state
level. And, of course, every state is different.
But,
you know, there there are some general themes
coming up, like certificate of need changes, different,
sort of assessments and transaction reporting.
Thinking about those state level sort of happenings
and developments,
what do ASC leaders need to be thinking
about now as they think about growth, partnership,
and navigating some of these changes? So it's
it's a great question. I think the interesting
the interesting point there is the duality between
the regulatory changes we're seeing across the nation.
So on one hand, you see states relaxing
the CON requirements or sometimes even full on
repealing the CON requirements with this, which is
great for our industry. It's it reduces a
barrier to entry.
And on the other hand, you see states
enacting these very expansive health care transactional review
laws, which are expensive,
create additional time and considerations for our transaction.
So it's a very interesting time
to be a provider or a developer in
the health care space.
I think that the where the rubber meets
the road on that and where we'll see
the most success is where,
states
really embrace
the importance
of the ASC joint venture. And I think
you see that in the Southeast and the
Georges and the Carolina where they're saying, look,
if you have a hospital in the county
that's partnering with a, physician practice, you'll get
the exemption from the CO and laws up
to, I think it's a $5,000,000
cap in in the Carolinas. And so
that is,
to me, where we're going to see the
most growth is where our states really start
to lean into the value that we're bringing.
Yeah. And this is,
I don't expect you to have, like, the
the be all end all answer to this
this next follow-up question that I'm just following
my curiosity on. But when you're talking about
helping policymakers
understand
the value of this shift, the value of
the ASC, Have you heard anything or seen
anything that's particularly effective? I just imagine for
folks who are
deeply
involved in this industry care a lot about
it, would want to know what's the most
effective way to get my state rep to
understand
what's going on here and where we need
their help?
Yeah. It that is it's a good question.
And when I think about the value that
we're bringing to the community,
it's affordable, accessible health care that it feels
like something that's not a massive endeavor. So
even now, you can go into the ASC
setting and do a total shoulder replacement. Right?
And they flip you upside down when you're
under anesthesia and they're taking your shoulder out.
That type of procedure seems
so much less daunting when you're doing it
in something that looks like a doctor's office
versus a hospital, and it's much more affordable
for the payers. And so I think what
we have to show our state, our local
representatives, and kind of the even the the
reimbursement
structure is that we're putting dollars back into
the community, into the pockets of our patients,
and also
bridging the the disconnect between people who would
not typically receive this type of care. Right.
Right. Because it's it they were typically be
more shut off from from that kind of
access.
That's an that's an interesting point. I'm gonna
ask you now sort of, like, there's so
many different things we could point to in
terms of what's really what's really important, what's
really pertinent. But if you had to narrow
it down to the single most
important regulatory or policy shift ASC leaders should
be preparing for right now,
what is it, and how that how should
they be preparing?
From my point of view, the the single
biggest pressure point is going to be bridging
the gap between reimbursement and rising costs. And
it's a it's going to be a good
problem to have because we are going to
continue to see increasing ASC volumes. But with
increasing ASC volumes means we need to understand
how our ASCs are making money and ensure
that the reimbursement rates for those new procedures,
are effectively compensating,
the provider.
Yeah. And that's gonna be essential to make
that
this access, this expansion of access that you
were hinting to possible. It's not gonna be
possible unless that gap is bridged. Right? Absolutely.
The physicians, they have a huge stake in
this, and this is to many, it's it's
their livelihood. This is what they do. And
so to continue to provide that care, they
need to be able to to have re
reimbursement. I mean, it has to meet their
costs. Yeah. Well, we we covered a good
bit of ground here, but there's, of course,
I think, several different avenues we could have
gone.
Before I let you go, is there anything
we didn't touch on you wanna share, or
maybe it's something you just wanna reemphasize, double
down on folks? What do you want people
to remember from from this listen? The the
most successful ASCs are the ones that invest
in their people. So I'd be remiss to
not highlight the value that the nurses, the
administrators,
all of the staff bring and the value
that they add to their local communities
by
working in the ASC industry, because that is
just unsung heroes of allowing the entire industry
to to expand.
Great place to leave it. Michelle, thank you
so much for coming on the podcast. We
also wanna thank our podcast sponsor, Holland and
Knight. You can tune to more podcasts from
Becker's Health Care by visiting our podcast page
at beckershospitalreview.com.