Allegheny Health Network’s ambulatory surgery centers had a record year in 2020.
Surgeries were up around 10% at the Pittsburgh-based integrated health system’s 10 ASCs, and Allegheny plans to move even more procedures into those facilities. Surgery centers generally have high physician and patient satisfaction given their convenience and efficiency and ASCs help ensure that more acute patients can be treated in hospitals, said Dr. Sricharan Chalikonda, Allegheny’s chief medical operations officer.
Health systems continue to invest in ambulatory surgery centers. While reimbursement rates are typically significantly lower than the inpatient setting, ASCs provide lower-cost alternatives and free up inpatient capacity.
Allegheny opts for the fully owned model rather than splitting equity with doctors, in part, because it wants to eliminate any perverse incentives that value finances over care quality, Chalikonda said, adding, “We have seen some situations where doctors say, ‘if this was a joint-venture arrangement, I would bring more cases here.’ But the reality is that we need to hold true to our values around quality patient outcomes. We want patients to want to come to ASCs versus doctors having a financial incentive to do procedures there.”
Joint ventures with physicians, though, can help systems attract and retain top talent. Along with investment, compliance risk for those that pursue the joint-venture route grows.
While systems aren’t legally obligated to meet each element of the anti-kickback statutes’ related safe harbors, ASC joint ventures could yield hefty fines if there is clear intent to boost referrals.
“If hospitals are potentially using ASCs to attract physicians, that does beg the question—what is exactly involved in the structure of the ASCs that is helping recruit and retain physicians?” said Susan Edwards, branch chief of HHS’ Office of Inspector General industry guidance branch. “There will obviously be attention on the construct of an ASC if a hospital is using it to recruit or retain physicians.”