ambulatory surgery centers (asc) · 5/15/2019 · 9 nys asc penetration per 100,000 population by...
TRANSCRIPT
Ambulatory Surgery Centers (ASC) :
Impact on Community Hospitals in CON Review
PHHPC Planning Committee
Date: May 15, 2019
2
• History and Background
• Current CON Review Process
• ASC Trends
• Policy Considerations
3
• Studies comparing ambulatory surgery outcomes in hospital
outpatient departments, ambulatory surgery centers, and
physician offices generally conclude that outcomes are
similar, regardless of setting, when risk-adjusted for patient
acuity.
• A high level comparison of costs and reimbursement shows
that, on average, procedures tend to be most expensive in
hospital settings and least expensive in physician offices,
with ASC’s in the middle.
History and Background
4
• Current need methodology was designed to encourage the
expansion of free standing ASC’s to enhance access.
• At the same time, the Department also recognizes the vital
role played by hospitals in our health care delivery system.
Many of these essential services are cross-subsidized by
services such as ambulatory surgery.
History and Background
5
History and Background
• Since the early 2000s, at PHHPC’s request, the
Department solicits feedback from surrounding hospitals
regarding the impact the proposed ASC would have on
their operations/financial viability when a hospital is not a
direct member of proposed ownership.
• Currently, the Department will only recommend disapproval
of a new site if the impact is such that the Department
concludes it will likely result in the closure of a local
hospital.
May 14, 2019 6
History and Background
• Since approximately 2006, PHHPC has imposed a limited
duration operating certificate on newly established
freestanding ASC’s, which do not have a hospital as a
direct operator or member, as a way to monitor ASC’s
efforts in reaching the un- and under- insured populations.
May 14, 2019 7
Current ASC Review Criteria
NYCRR 10 Section 709.5
• Documentation that proposed facility/service will be sufficiently used to make it financially feasible.
• Documentation that proposed facility/service will increase access, including to the underserved.
• Documentation that proposed facility/service will increase availability of services, including a written policy to provide charity care.
• Documentation that proposed facility is willing and able to safely serve patients in accordance with NYCRR 10 Part 755.
May 14, 2019 8
• Limited Life, 2% Charity Care and an appropriate
percentage Medicaid.
• Soliciting feedback from surrounding hospitals as to the
impact the proposed ASC would have on their
operations/financial viability.
Policy
Current ASC Review Criteria
9
NYS ASC penetration per 100,000 population
by year (2007-2008; 2017-2019)
Year 2007 a 2008 a 2017 a 2018 a 2019 b
Population Estimate 19,132,335 19,212,436 19,590,719 19,542,209 19,875,625
Ambulatory Surgery Centers c 290 284 371 378 383
Ratio (ASCs/100,000 People) 1.5 1.9 1.9 1.9 1.9
a New York State Department of Labor
b 2019 population estimates from a web source,http://worldpopulationreview.com/states/new-york-population/
c Health facility information system (HFIS) 2017-2019
Prepared on 5/1/2019 by OPCHSM-DMAR
10
Number of ASCs per Part B beneficiary varies widely across states
Source: March 2019, MedPac analysis
of CMS denominator file for 2017
Nu
mb
er
of
AS
Cs p
er
100,0
00 b
en
efi
cia
ries
40
35
30
25
20
15
10
5
0MD AK NJ NE AZ NV MS DE UT IN LA TX ND PA OH MT MN SC IL MI RI NM NY KY AL VT
GA WY ID WA CO CA KS SD OR TN AR FL NH HI MO CT WI OK NC ME MA IA VA DC WV
State
45
11
New York State Ambulatory Surgery Centers by Facility Type and Region
HSA Region Hospital Based
Hospital Extension Clinics
Diagnostic &
Treatment Center Total
Western (HSA=1) 23 3 13 39
Finger Lakes (HSA=2) 17 3 6 26
Central NY (HSA=3) 22 7 18 47
NYPENN (HSA=4) 4 1 0 5
Northeastern (HSA=5) 25 5 14 44
Hudson Valley (HSA=6) 26 2 20 48
NYC Boroughs (HSA=7) 53 13 58 124
Nassau-Suffolk (HSA=8) 21 4 25 50
Total 191 38 154 383
New York State ASC’s By Facility Type/Region
Source: HFIS, as of 4/25/2019
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New York State ASC’s (excluding hospitals &
their extension clinics) by Region
Single Specialty
HSA Region
Multi-
SpecialtyMultiple Single
SpecialtyGastro-
enterology
Ophth-
mology
Orth-
pedics
Pain
Management
Non
Specified Total
Western (HSA=1) 8 1 1 2 0 0 1 13Finger Lakes (HSA=2) 5 0 0 1 0 0 0 6Central NY (HSA=3) 4 5 2 1 3 2 1 18Northeastern (HSA=5) 3 1 1 5 2 2 0 14Hudson Valley (HSA=6) 13 1 4 2 0 0 0 20NYC Boroughs (HSA=7) 26 6 13 7 1 2 3 58Nassau-Suffolk (HSA=8) 14 2 7 1 1 0 0 25
Total 73 16 28 19 7 6 5 154
Source: HFIS, as of 4/25/2019
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Distribution of Ambulatory Surgery
Procedures by Facility Setting in NYSData Source: SPARCS
2007
Hospital
Hospital Extension Clinic
Diagnostic & Treatment Center
87.4%
1.9% 10.7%
2017
61.4%7.8%
30.7%
Hospital
Hospital Extension Clinic
Diagnostic & Treatment Center
14
Distribution of Most Common Ambulatory
Surgery Procedures by Facility Setting in NYS
Data Source: SPARCS
Colonoscopy and Biopsy (CCS=76)
2007
Hospital
Hospital Extension Clinic
Diagnostic & Treatment Center
2017
Hospital
Hospital Extension Clinic
Diagnostic & Treatment Center
46.9%
7%
46.1%76%
20.3%
3.7%
15
Distribution of Most Common Ambulatory
Surgery Procedures by Facility Setting in NYSLens & Cataract Procedures(CCS=15)
Data Source: SPARCS 2017
Hospital
Hospital Extension Clinic
Diagnostic & Treatment Center
28.7%
6%65.3%
2007
Hospital
Hospital Extension Clinic
Diagnostic & Treatment Center
2.6%
40.1%
57.3%
16
Between 2008 and 2018: 87 ASC’s (DT&C’s)
have been approved, 1 disapproved
0
2
4
6
8
10
12
14
16
18
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
17
Hospital Affiliated ASCs 11%
Independent ASCs 89%
Hospital Affiliated ASCs vs. Independent ASCs (Approved 2008-2018)
Hospital Affiliated ASCs
Independent ASCs
18
Counties with Critical Access Hospitals
and Sole Community Hospitals
Source: HFIS, as of 05/07/2019.
Chemung
Onondaga
Monroe
Livingston
Orange
Schenectady
Montgomery
Greene
Putnam
Saratoga
Erie Albany
Allegany
Broome
Columbia
Dutchess
Fulton
Genesee
Hamilton
Niagara
Oneida
Ontario
Rensselaer
Westchester
Rockland
Seneca
Tioga
Warren
Washington
Wayne
Legend:
Primary Care Hospital - Critical Access Hospital (19)
Hospital - Sole Community Provider (20)
Ambulatory Surgery Centers - Hospital Extension Clinics (21)
Ambulatory Surgery Centers - Diagnostic & Treatment Centers (71)
Distribution of Critical Access Hospitals, Sole
Community Hospitals, Ambulatory Surgery Centers -
(DT&Cs) and Ambulatory Surgery Centers - (Hospital
Extension Clinics)
in Upstate New York Counties.
19
Policy Considerations
• What factors should be considered in recommending
approval or disapproval of a proposed ASC?
• When should limited life be imposed?
20
Thank You