How to Get More Referrals and Increase Market Share: Arrangements with Ambulatory Surgical Centers

Stephen Tweed | August 16, 2017 | Executive Strategy Retreats, News and Views
By Elizabeth Hogue Outpatient surgeries, including joint replacements, have outstripped inpatient surgeries over the last 10 years. Specifically, from 1990 to 2014 outpatient surgery rates have grown 15.4%, which has resulted in a drastic reduction in total inpatient surgeries. According to the American Hospital Association's Annual Survey data, there were 9.015 million inpatient surgeries and…
By Elizabeth Hogue

Outpatient surgeries, including joint replacements, have outstripped inpatient surgeries over the last 10 years. Specifically, from 1990 to 2014 outpatient surgery rates have grown 15.4%, which has resulted in a drastic reduction in total inpatient surgeries. According to the American Hospital Association’s Annual Survey data, there were 9.015 million inpatient surgeries and 17.386 million outpatient surgeries for 2014.

 

This means that Medicare certified home health agencies and private duty agencies must now look to ambulatory surgery centers (ASCs) as a major source of referrals of patients. Since an increasing number of joint replacement surgeries are being performed in ASCs, it is increasingly important for Medicare certified home health agencies to focus on ASCs as sources of referrals. Likewise, private duty agencies should look for referrals of patients who are not able to return home without assistance following outpatient surgery, but who do not meet the eligibility requirements of the Medicare home health benefit.

 

Enter a Preferred Provider Agreement.
 Both home health agencies and private duty agencies may, for example, wish to enter into Preferred Provider Agreements with ASCs. These Agreements could be exclusive. They could also provide that, in the absence of a choice by patients, patients will be referred to preferred providers. A key area of concern about Preferred Provider Agreements is how to help ensure that patients’ right to freedom of choice is honored.

 

New Rules for Discharge Planning
 
Some ASCs are owned by hospitals, which raises the question of whether ASCs owned by hospitals are required to comply with Conditions of Participation (CoPs) for discharge planning for hospitals of the Medicare Program. Current CoPs for discharge planning require hospitals to present lists of Medicare certified home health agencies, but not private duty agencies, to patients from which they may choose providers. Current CoPs for discharge planning, however, do not require hospitals to present lists of Medicare certified home health agencies from which patients may choose at outpatient surgical sites, including ASCs.

 

 It is important to note, however that the Centers for Medicare & Medicaid Services (CMS) published proposed regulations governing discharge planning by hospitals in the Federal Register on November 3, 2015. If these proposed regulations are finalized as drafted, hospitals will be required to comply with CoPs for discharge planning, including the presentation of lists to patients, at all outpatient surgical sites, including ASCs.

 

 Currently, however, both ASCs owned by hospitals and so-called freestanding ASCs are not required to present lists of home health and private duty agencies to patients or to offer choice to patients so that they can choose providers. Consequently, unless patients voluntarily express a choice of home health and/or private duty agencies, ASCs may refer patients to their preferred providers consistent with Preferred Provider Agreements.

 

Consequently, there is an opportunity for Medicare certified home health agencies and private duty agencies to garner referrals from ASCs through the use of Preferred Provider Agreements without violating patients’ right to freedom of choice. Like so many things in healthcare these days, now is the time!

Elizabeth

(877) 871-4062
ElizabethHogue@ElizabethHogue.net

©2017 Elizabeth E. Hogue, Esq.  All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author. Reprinted with Permission.
Elizabeth E Hogue LLC, 1875 I Street, NW, Suite 500, Washington, DC 20006

 

Stephen Tweed
Stephen Tweed, CSP, began his journey as a business strategist in home health care in 1982. Today, Stephen is among the top thought leaders in Home Care strategy and management. He has worked with top 5% companies from across the US. He is a sought after speaker at from national and state association events.

Related Posts

Extraordinary Transformation: A blueprint for leaders who want to Transform their Organization

June 5, 2024
By Stephen TweedAs a leader in Home Care, are you working on transforming your organization?Are you looking for strategies and insights to grow your business and get ready for the future?I've just finished reading an amazing book by my friend and professional speaking colleague, Dr. Nido Qubein. "Extraordinary Transformation: An Entrepreneurial Blueprint for Leaders Who…

Stephen Tweed’s Podcast and Webinar Appearances

May 30, 2024
As a significant Thought Leader in the Home Care industry, Stephen Tweed is frequently invited to be a guest on industry podcasts and webinars. Here are links to some of Stephen's recent appearances.July 2024 - The Caregivers Toolbox with Ryan McEniff - What Consumers, Caregivers, and Referral Partners want from Home Care. Ryan McEniff is…

The Forces and Trends Shaping the Future of Home Care.

May 14, 2024
By Stephen TweedWhat will the Home Care Industry look like in five years?Over the past two decades I've been actively engaged in the Home Care Industry, and monitoring the Forces and Trends that are shaping the future of our industry. While much of the growth of Home Care is driven my the entrepreneurial spirit of…