SAme-Day Surgery Manager: With healthcare reform moving on, now what?
With healthcare reform moving on, now what?
By Stephen W. Earnhart, MS
CEO Earnhart & Associates
Houston, TX
With the elections over, the majority of the country has spoken. Like it or not, healthcare is going to irrevocably change in the United States. There are challenges to say the least, but there are also lots of opportunities for the U.S. healthcare industry as we start down this path.
This is how I see it winding up:
• Hospitals.
The number one goal for accountable care organizations (ACOs) is to reduce costs to enjoy a reasonable reimbursement for their services. Hospitals cannot reduce costs. It just cannot be done in their current environment. From a surgical standpoint, hospitals must find a lower cost alternative to in-house surgery.
Quickly, outpatient surgery is going to reach the point that 85% of all surgery performed in the United States can be done within a facility that allows one or two overnight stays. This absolutely cannot be done cost effectively in the hospital! Why? Too much overhead, too much red tape, and too much bureaucracy.
Hospitals are going to have to develop off-site, satellite surgical hospital outpatient departments (HOPDs) to become more efficient and cost-effective. Earnhart & Associates has developed many of these centers, and they essentially function like a freestanding surgery centers but without surgeon partnerships or ambulatory surgery center (ASC) reimbursement that drain the profitability away from the hospital. These facilities can be built in a fraction of the time and expense of building out internal hospital surgical departments. They are typically managed by an outside management company, similar to how current for-profit ASCs are run.
• ASCs.
Their day in the sun is winding down as more hospitals actively compete against them. Capital is tight for ASCs, and there are fewer entrepreneurial surgeons willing to risk it all in the face of massive healthcare changes. Most ASCs are and have been built with an exit strategy to sell to hospitals eventually. That “eventually” is much closer than it was before the elections.
As I mentioned months ago in my column, start lining up relationships with your local hospital. Like it or not, it might come down to that. But with so many surgery centers near hospitals, there only will be a few that are chosen.
There are still steps ASCs can take to remain profitable and flourish in the upcoming changes, so it is not all bad. Be patient, but also receptive.
• Patients.
While many more will have insurance, access will be grossly delayed to most due to not enough entry points and not enough money to develop more. Quickly we will see longer wait times for doctor visits, diagnostic work-ups, and treatment. This is just a new fact of life with the coming changes. The days of going to see your doctor and receiving treatment quickly soon will be over. You now have 30,000,000 more people ahead of you in a rapidly shrinking industry where healthcare portals are slamming shut.
• Surgeons.
Most of you will become employees of hospitals and healthcare systems. The majority of you will welcome it. With company-paid malpractice, a fixed income with incentive bonus (that practically none of you will reach), office staff that is no longer your responsibility, a predictable work schedule, and a 40-hour work week with no emergencies to deal with, you will be wondering why you never considered it before. The downside for some of you will be working for people who don’t understand healthcare and your acceptance of something less than you are used to having.
• Solution.
There really is only one solution or “antidote” to the above scenarios: money, of course. You will need money to buy access for yourself, your families, and loved ones to the hundreds, if not thousands, of “cash-only” surgery centers, emergency departments, and hospitals that will spring up all over the country as those with resources are willing to pay out of pocket for what we now take for granted. A large portion of healthcare intervention is episodic, so most of us would be willing to bypass or “buypass” the mess ahead by writing a check. Start saving. [Editor’s note: Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates’ address is 238 S. Egret Bay Blvd., Suite 285, Houston, TX 77573-2682. Phone: (512) 297.7575. Fax: (512) 233.2979. E-mail: [email protected]. Web: www.earnhart.com.]
With the elections over, the majority of the country has spoken. Like it or not, healthcare is going to irrevocably change in the United States. There are challenges to say the least, but there are also lots of opportunities for the U.S. healthcare industry as we start down this path.Subscribe Now for Access
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