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For ambulatory surgery centers, it’s all about networking

Obamacare has increased emphasis of joining insurance groups

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Trinitas CEO Gary Horan: The hospital business model needs to change.
Trinitas CEO Gary Horan: The hospital business model needs to change. - (COURTESY TRINITAS REGIONAL MEDICAL CENTER)

New Jersey's more than 200 ambulatory surgery centers have always had a lot in common.

They were free-standing facilities where doctors do procedures that don't require an overnight hospital stay. They rarely were in-network. And hospitals saw them as a serious competitor.

That's all changing under the Affordable Care Act.

Because insurers have redesigned their health plans to give members financial incentives to use in-network providers (capping reimbursements to out-of-network ASCs in the process), many centers are now looking to move in-network to assure themselves of a consistent stream of patients and revenues.

Larry Trenk, president of the New Jersey Association of Ambulatory Surgery Centers, said the shift is coming.

“Many centers that are predominately out-of-network are going to shift in-network because they realize they need to capture market share,” he said.

Many already have.

Mark Manigan, a health care attorney for Brach Eichler, estimated the majority of ASCs are now entirely or partially in-network.

“The insurance carriers have been so effective at redesigning their out-of-work benefits that it's really becoming hard to be an out-of-network provider,” he said.

Claudette Downs, the administrator of the Short Hills Surgery Center, has learned that first hand.

Downs said the center was completely out of network when it opened in 2005. Today it is in-network will all the major insurers.

“Insurance companies have become much more aggressive (about steering patients to in-network),” she said. “We ran the risk of losing patient volume.”

Hospitals have been taking notice.

Under pressure to provide out-patient care whenever possible, many have been building or acquiring their own ASCs.

In February, Trinitas Regional Medical Center in Elizabeth will open a new 9,500 square foot ASC within its new cancer center.

Chief Executive Officer Gary Horan said there always will be a need for in-patient hospital care but feels ambulatory surgery centers are a big part of the future.

“For hospitals to remain strong, the business model has to be adjusted to accommodate the changes taking place, and the focus on outpatient care is part of that,” he said.

Horan said 45 percent of the hospital's surgeries already are outpatient, and Trinitas sees same-day surgery growing 10 and 15 percent over the next three years.

Trinitas currently does about 4,000 ambulatory surgeries a year, which could rise to 5,000 with the new facility, which will do procedures such as hernias, laparoscopic surgery, orthopedics and pain management.

Insurers across the state welcome the new business.

Horizon Blue Cross Blue Shield of New Jersey has 181 ASCs in its network, up about 50 percent in the last three years, according to Jim Albano, vice president of network management.

And Horizon is open to bringing more ASCs into its network.

“We are still interested in adding more ASCs, and we would take a look,” Albano said.

Michael Costa, Aetna's head of network for New Jersey, said his company has about 150 ASCs in its network across the state, including a dozen that came on board this year.

“Some centers that had been out of network for years” have recently come in, Costa said.

And while Costa said a significant number are still out of network, it may only a matter of time before they join.

Trenk said hundreds of thousands of procedures are done each year in New Jersey ASCs, a number that will only go up as technology improves.

“More and more procedures are going to be done in ASCs,” Trenk said.

E-mail to: beth@njbiz.com
On Twitter: @bethfitzgerald8

Beth Fitzgerald

Beth Fitzgerald

Beth Fitzgerald reports on health care, small business and higher education. She joined NJBIZ in 2008 after a 34-year career at the Star-Ledger and has been reporting on business in New Jersey since 1978. Her email is beth@njbiz.com and she is @bethfitzgerald8 on Twitter.

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