Trends Shaping the Future of the ASC Industry

More now than in the past, the soaring cost of hospital care is leading physicians and patients to look for different venues for medical treatment. The average cost of a hospital stay in 2010 was $9,700, whereas for Americans ages 65 to 84 that number soared to $12,300. It is not surprising that an increasing number of patients are choosing to undergo procedures in Ambulatory Surgery Centers (ASCs), rather than in typical hospital settings. Colonoscopies, for example, one of the more common services provided by ASCs, cost patients on average a co-payment of just $76. A similar operation in a hospital, meanwhile, can cost the patient $186. While ASCs offer many benefits, there are a few key trends transforming the ASC industry which physicians, from surgeons to CRNAs to anesthesiologists, and their patients should be acquainted with. 

Since the first Ambulatory Surgery Center was established in 1970, ASCs in the United States have collected less reimbursement from Medicare than hospitals have for carrying out identical procedures. ASCs collect on average only 49% of the fees earned by hospitals and hospital-affiliated centers. For example, an ASC will receive a payment of only $980 for conducting a cataract surgery, whereas a hospital which performs the same operation will earn $1,760. This could change in the near future, however. Government health officials are working to eliminate the payment disparity between hospitals and ASCs in order to foster the growth of the ASC industry. The ASC Access and Quality Act of 2017, introduced in the House of Representatives in March of 2017, seeks to ensure fair compensation for ASCs. Moreover, the newly appointed chief of the Department of Health and Human Services, Secretary Tom Price, has a track record of supporting ASCs. He once owned an ASC himself, and worked as an orthopedic surgeon before he was elected to Congress. In his new role he may try to promote ASCs as a high-quality and cost-effective health care option for patients

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            ASCs are well-known for their autonomy, but a recent trend in the medical industry could change this. Hospitals have ownership stakes in just 21 percent of ASCs, and fully own only 3 percent of ASCs, whereas 90 percent of ASCs are owned in full or in part by surgeons and physicians. Over the last few years, however, prominent insurers and hospitals have made efforts to purchase ASCs in order to extend their presence in the healthcare market. ASCs are known for being small, local businesses – almost 70% of ASCs employ 20 people or fewer. If insurers and hospitals continue to buy ASCs this could change, however. ASCs could become more profitable as a result of these mergers, though, as they would have access to more capital and be able to procure supplies at lower costs. The future of ASCs in the United States is not certain, but these developments provide clues as to how the industry will likely change in coming years.

Optimizing the Anesthesia RFP Process (Request for Proposal)

Hospitals looking to change their anesthesia service providers will likely need to create a request for proposal document (RFP) to send to new potential vendors. RFPs can be time-consuming for both the buyer and the vendor, so it is in both parties’ best interests to make the process as straightforward as possible. While this may seem like a daunting task, there are a couple tactics that can be implemented to optimize the anesthesia RFP process and to create the best match between the vendor and hospital.

1. Hospitals should know what their needs are and convey them clearly.

A hospital will likely choose to change vendors based on concerns regarding the cost and/or service of the current vendor. The hospital should identify where the current vendor is falling short and gear a portion of the RFP to understanding how other vendors approach those areas. In general, RFPs are most effective when they are specific and allow for standardized comparisons of vendor responses during the evaluation portion of the selection process. Some hospitals will allow vendors to contribute to the RFP, a tactic that reduces the time spent by the buyer, but potentially biases the RFP towards a specific vendor and reduces its specificity to the hospital’s needs. In the interest of developing a fair and representative RFP, the hospital should handle the RFP creation process independently. However, the vendors do not need to be completely blind in the selection process; according to the TechRepublic, providing the evaluation criteria of the hospital may help vendors provide responses better geared towards the hospital’s priorities.

2. Representatives from the teams affected by the change should be included in the discussion.

Changing health service vendors not only affects the business end of the hospital but also the health care aspect. As a result, it is important to include a diverse group of stakeholders in the conversation prior to and during the vendor change. Different teams within the hospital will have different requirements for the anesthesia service. According to the Becker’s Health IT and CIO Review, addressing the stakeholders’ concerns early on in the vendor selection process will ease the implementation and transition phases. Additionally, while the current vendor should not be included in the RFP drafting process, the hospital should have a discussion with that vendor regarding their performance months before collecting RFP responses to avoid pressure to renew services.

3. Make sure that vendors follow through with their claims.

The hospital should make sure to hold the vendor to the specific standards and claims described in the vendor’s response to the RFP. If additional promises were made by the vendor before the selection committee, they must be added to the written contract or they may not be viewed as commitments by the vendor. The hospital also should request a list of references from the top candidatesand follow up with them; in some cases, a site visit could be beneficial in understanding how the service is being implemented in other locations.

New HIPAA Rules Involving Electronic Communication

The Health Insurance Portability and Accountability Act, enacted in 1996, was established to protect patients’ health information and set regulations on how health records are accessed. Healthcare providers now are required to provide electronic access to each patient’s health information. With the rise of electronic communication, many healthcare providers have started to use email and text (SMS) messaging to communicate with patients more quickly and easily. With the increased dependence on electronic communication, many people are concerned with how HIPAA applies to electronic communication.

As a result of the rapid pace of electronic communication development, many people have been confused on how the HIPAA Security Rule applies to modern electronic communication such as emails and text (SMS) messaging. The new HIPAA rules now tell healthcare providers to “[i]mplement technical security measures to guard against unauthorized access to [electronic protected health information (ePHI)] that is being transmitted over an electronic communications network”. To prevent unauthorized access to ePHI, healthcare providers must confirm that there is secure transmission of patient health information.

Healthcare providers can offer secure access to healthcare information online through encrypted messages and emails or using a password protected patient login. Unencrypted messages may be read on a public Wi-Fi network so encryption provides protection in the event that a message is intercepted. Patient portals that require patient login provides password protection of patients’ health information. These methods allow healthcare providers to share health information with their patients in a protected and convenient way.

While the new HIPAA regulations do not specifically prohibit text (SMS) messaging as a way to communicate patient health information, most text message communication is not encrypted or password protected and is therefore not compliant with HIPAA. In order to be HIPAA compliant, healthcare providers must first confirm that the text (SMS) messaging feature that is being used meets, or is exempt from, the safety regulations imposed by HIPAA. Otherwise, text (SMS) messaging without proper safety measures is not permitted.

Healthcare providers may be able to communicate health information via unsecure email and text (SMS) messaging if the email and text (SMS) message communication is from the patient to the healthcare provider. HIPAA states that its rules “[do] not apply to the patient. A patient may send health information to you using email or texting that is not secure. That health information becomes protected by the HIPAA Rules when you receive it”.  Therefore, healthcare providers must be aware that they should alert the patient of the risks of using unencrypted email or text message communication. The patient can choose to decide whether they would like to continue using this form of electronic communication, and the healthcare provider can continue using email or text (SMS) messaging, as long as it is acceptable for the patient.

HIPAA rules not only apply to communication between patient and healthcare providers, it also applies to communication between providers, employees, and third parties such as insurance companies. If the communication does not include the patient, all forms of electronic communication of patient health information must be encrypted or have a password protected system such as a user login.

The evolving healthcare environment affects every healthcare provider, including anesthesiologists. After the introduction of new regulations such as the changes in HIPAA, anesthesiologists should contact their employer, or the anesthesia management company they work for, in order to reevaluate their plan to provide the best anesthesia service for patients and ensure a sustainable business model. All healthcare providers must stay up to date on any new revisions to the HIPAA regulations. As people continue to rely heavily on electronic communication, it is essential for healthcare providers to continue discussing both how to best meet the needs of their patients and how to best protect their health information.

Pre-surgical Services

Pre-surgical services are a vital component to providing quality healthcare. While pre-surgical services vary across healthcare providers, specialties, and procedures, many guidelines remain similar.Generally, healthcare providers will require a pre-admission appointment up to a month in advance where a healthcare provider will conduct a pre-surgical assessment, go over any specific instructions, and conduct any required testing before the procedure (3, 5). In addition to providing diagnostic testing, many healthcare providers use the opportunity for a pre-admission appointment to include pre-operative teaching and care planning to help ensure a satisfying surgical experience for the patient and patient’s family (4).

For those undergoing a surgery involving anesthesia, a medical professional will begin by taking a patient’s medical history and conduct a physical to ensure that the patient may undergo the procedure safely (1). Prior to the procedure, patients will be given the appropriate information regarding the procedure, including any special instructions regarding intake of food and liquids. Patients will also receive instructions on any necessary medications pre- and post-operation. In some instances, the anesthesiologist will consult with patients prior to the day of the procedure. Anesthesia providers will “review your health history, medications, allergies and past experiences with anesthesia, and recommend the best plan for your care” (1).

Communication between physicians and patients prior to surgery is important in ensuring a safe and positive surgical experience for patients. Many patients prior to undergoing surgery may be concerned about the risks associated with anesthesia. While the overall risk of anesthesia-related complications is extremely low, it is the responsibility of the healthcare professionals to assess the risks of the procedure and anesthesia services, decide on the optimal procedure to minimize any possible risks, and communicate and consult with the patient throughout the process (1). Additionally, there are many other factors to consider during any pre-surgical meetings. For example, patients should know that they should always inform their physician if there are any changes to their health, such as a cold, that might impact surgical care so that the healthcare team can decide whether there needs to be any changes to the procedure. According to a study published by The Journal of the American Society of Anesthesiologists, “a communication gap already exists between patients and physicians on the topic of [complementary and alternative medicine]”, indicating that anesthesiologists and other physicians must continue to work on improving communication during pre-surgical care (2).

To improve a patient’s surgical experience, physicians can work on clearly communicating information regarding the surgery, including the diagnosis, surgical process, and anesthesia to patients during any pre-surgical appointments (7). A study shows that patients who report more knowledge of the surgical procedure and anesthesia also had lower pre-procedural anxiety levels. Physicians can also find “reliable, valid information on patient pre-surgical risk factors, process of care during surgery, and 30-day morbidity and mortality rates […] for all major surgical procedures,” which can help physicians assess risk of surgery (6).  All healthcare professionals involved in surgery should stay up to date on any research regarding pre-surgical services in order to provide quality care and ensure the best outcomes.

A BRIGHT OUTLOOK FOR CRNAS IN 2016

For the past 150 years, Certified Registered Nurse Anesthetists (CRNAs) have experienced considerable success and respect in the healthcare industry. The first advanced nursing specialty to ever be recognized formally in the United States, CRNAs, hold a position very similar to an anesthesiologist—administering anesthesia to patients and closely monitoring the patient during surgery and throughout the recovery process. However due to the versatility of the CRNA position and the universal demand for anesthesia, CRNAs are able to work in many different facets of the medical field. From surgery, to dentistry, to the battlefield, CRNAs are essential to efficient care in a variety of specialized industries.

Delivering more than 40 million anesthetics every year, CRNAs dispense 65% of the total anesthetics annually supplied. Furthermore, a study from the American Association of Nurse Anesthetists (AANA) found that CRNAs are essential in rural or medically underserved areas that would not normally have an anesthesiologist, as CRNAs supply almost 100% of delivered anesthesia in such areas. Due to the ability of CRNAs to safely and effectively deliver anesthesia to patients, 17 states have passed legislation that allows CRNAs to practice independently, free from any physician supervision. Along with autonomy, CRNAs are consistently recognized for their skill and expertise, receiving a median income of roughly $160,000 annually.

Although CRNAs have been welcomed for decades with job openings across the country and generous compensation, the question remains: What will the job market look like for CRNAs in 2016 and in the years to come?

In short: Excellent.

Taking into consideration the demographics of the American populace and of current CRNAs, as well as the changing demands of the healthcare industry, the job market for CRNAs is extremely stable, with the US Bureau of Labor Statistics estimating a job growth rate of 31% over the next decade, higher than almost all other medical professions.

Although the number of CRNAs graduating has more than doubled since the nineties, there is still a significant demand for CRNAs in the job market. A recent study by the Rand Corporation concluded that there is a shortage of both CRNAs and anesthesiologists across the United States, with CRNAs being particularly in demand in urban centers of the Northeast. This shortage is quite significant to the healthcare industry because of the demands of an aging baby boomer population that requires efficient and specialized medical services. In fact, due to these demographic changes in America and the necessity of skilled anesthetists, Rand predicts that this shortage of CRNAs will continue until 2020, even with an increase in the amount of available CRNAs.

Just as the United States population is aging, so are practicing CRNAs. A demographic analysis of CRNAs from the AANA shows that the average age of a CRNA is 47.3 years old. Considering that the average retirement age is 65, a very significant number of current CRNAs will be retiring in the next twenty years, with 19% planning to retire by 2019. Due to this loss of professionals, in 2016 the CRNA specialty will undoubtedly be looking to hire graduating CRNAs that have thirty or more working years and the desire to work in such a high-demand and growing industry.

Since the implementation of the Affordable Care Act (ACA), healthcare providers have been pressured to cut costs and maximize efficiency, causing them to turn to CRNAs as anesthesia providers, due to their reduced expense to hospitals and insurance companies. Additionally, the expansion of Medicaid under the ACA has caused CRNAs to be in critical demand in the job market. CRNAs are the primary providers in underserved communities and specifically for those that are Medicaid eligible. With 15.8 million more people gaining Medicaid coverage since 2013 and an estimated 22.3 million more expected to become eligible, CRNAs will play a crucial role in supplying anesthesia management services to the newly insured.

Although the healthcare industry is rapidly changing as it responds to the passage of the ACA and an aging populace, the security of the CRNA position is remaining constant across the country as CRNAs continue to offer cost-effective and skilled care at a time when the industry needs it the most.

If you are interested in applying for a part-time or full-time CRNA position, Xenon Health is interested in you. You can simply fill out an online form at http://xenonhealth.com/contact-us/