Optimizing Ambulatory Care Strategies for Key Procedures and Services

By The SHSMD Team posted 20 days ago


Many hospitals, health systems, and other medical facilities are moving procedures typically addressed in an acute care environment to an ambulatory setting. There are varying reasons for this trend, according to Ross Swanson, Chief Operating Officer at Corazon, Inc.

First and foremost? The patient.

“There are a lot of patient requests for easier access to care,” states Swanson. “Put yourself in the shoes of a patient who needs to have a complex service done, that can now be handled in these new environments. There's a consumerism aspect to it.”

Entities like Centers for Medicare & Medicaid Services (CMS) are responding to this consumerism by making more applicable payment methods for procedures that were once only reimbursed on the acute care side. So, explains Swanson, it’s really a double-pronged approach.

“There’s the patient side that's really pushing this factor. And then you have the federal payment system and even commercial third-party payers also pushing for this, because they know the care that's rendered is done in a much more operationally efficient manner. There's a much lower cost of care in these settings.”

Some critics might question the outcomes of procedures performed in ambulatory versus acute care settings. Data has shown that patients are experiencing outcomes that are either equal to or exceed what they were experiencing in acute care environments—which is also driving the movement.

Determining Feasibility with a Multi-Step Approach

Of course, facilities cannot make the acute-to-ambulatory transition overnight. Swanson shares a multi-step approach to achieving a successful transformation.

1) Make a high-level assessment of what is permitted in the market. There are still a number of regulatory constraints organizations must consider. “You have to really look at your current local market first and say, ‘What are the restrictions or barriers that can be up against me in terms of what procedures I'm considering moving?’”

2) Consider how many patients are “available” within a given service. Does it make sense to make this move if you don't have enough volume or just not enough market catchment to do it?

3) Assess what competitors are doing, as well as how your physicians may respond. “Oftentimes, if you have a group of physicians who are loosely aligned or perhaps even in pure contradictory terms with the organization, it might not be the best route for you to take,” cautions Swanson.

4) Perform a financial analysis and ask: What does the business case look like? “The patient case is already there. It's been made,” he adds. “It's, ‘How can we afford to do this? What is the bottom line going to look like when we look at the specific procedures?’”

That last component can become a bit tricky, because payment for these procedures does not equal the same reimbursement a hospital would get. This means facilities on the outpatient side need to be much more operationally efficient to garner a bottom line. But, many of them can do it—and are doing it.

“We're not saying it's a negative financial picture. You just have to be very cautious. You need to be very careful, and you need to be extremely coordinated with how patients move through that system. Most of the centers in the U.S. that offer [these services] today are accomplishing their goals and still seeing positive returns, even with decreased reimbursement,” assures Swanson.

No Time to Waste

While an acute-to-ambulatory move may not be the right fit for every organization, Swanson says the trend is only gaining momentum. Hospitals and health systems should start preparing now, so they’re fully aware of what it takes to make the changeover.

“Prepare for the move to ambulatory, even if it's outside of your comfort zone and perhaps even outside of your belief system in terms of where you think things should be happening—because the bus has already left the station.”

Learning More

  • To learn more about this shift in care and how it may impact your organization, ensure you are registered for SHSMD Connections conference to receive access to the recording of his in person session at SHSMD Connections Conference, September 20, 2021. shsmd.org/education/annualconference for event information and registration.
  • To listen to an in-depth conversation on this topic with Ross Swanson, Chief Operating Officer at Corazon, Inc., click here to listen to the recording of his SHSMSD’s Rapid Insights podcast.
Headshot of Ross Swanson
Ross Swanson
Chief Operating Officer at Corazon, Inc.