The power of any political constituency is directly connected to that group’s ability to organize itself, create a clear message and speak with one voice. For many years, the ambulatory surgery center (ASC) community has been able to survive with a lower degree of political unity, as compared to other segments of healthcare. This was because ASCs were a relatively small component of the healthcare system and were, therefore, a low political priority.

This environment has changed dramatically, and we are entering a period in which our past efforts as an industry are not adequate to guarantee our future. In order to ensure that ASCs continue to play a valuable role in the healthcare system (improving the quality of care and lowering the cost of care), a significantly higher level of political engagement is required across the industry. We need to organize to a much greater degree, speak with a greater degree of unity, and invest significantly greater resources. Further, we believe that the ASC Association (ASCA) should speak as the common voice of our industry.

There are three main reasons why the political environment has changed for ASCs. First, ASCs are now a material part of the healthcare system, performing roughly 40 percent of all outpatient surgeries and procedures. While Medicare payments to ASCs remain less than 1 percent of total Medicare expenditures, ASC payments now exceed $3 billion per year, which is significantly higher than five or 10 years ago. Legislators are also aware that there would be a significant additional cost to the Medicare program if the ASC industry did not exist. Second, healthcare reform legislation has significantly increased the engagement and attention of legislators and the executive branch on healthcare policy. This focus will likely rise in the coming years, as pressure to reduce Medicare costs increases. It is a near certainty (in our judgment) that the healthcare reform bill will not produce the expected level of cost savings and efficiency — which will therefore require the enactment of further cuts to provider rates in the coming years.

Third, the magnitude and trajectory of our federal budget deficit and required debt will place unprecedented pressure on federal spending in the next five to 10 years. Given that Medicare and Medicaid account for nearly 40 percent of total federal spending, we expect an even higher level of pressure and attention on Medicare cost savings.

These financially challenging conditions serve to make the ASC community an even more indispensible component of the healthcare system. There are few areas of the healthcare system where two equally safe patient-care settings exist, such as ASCs and hospital outpatient departments, but one is delivered at a 45 percent cost savings to Medicare. The preponderance of physicians, nurses and healthcare leaders that we interact with concur that shifting more outpatient surgeries to the ASC environment will result in equally outstanding clinical outcomes, as well as significant savings to the healthcare system. The challenge to the ASC community is translating what we know to be true into an effective message that resonates in Washington, D.C. There are five main steps to accomplish this.

First, we must continue the efforts of the ASC Quality Collaboration (ASCQC) to evidence the outstanding patient care provided in the ASC environment. The ASCQC has achieved endorsement from the National Quality Forum of six clinical measures. Nearly 25 percent of all ASCs now voluntarily report quality data to entities that send it on to the ASCQC, which reports aggregate results quarterly. With new federal quality reporting requirements in the works for 2012, we need the remaining 75 percent of ASCs to understand the importance of collecting this vital information.

Second, we must use these measures and the clinical toolkits provided by the ASCQC to create an industry standard in vital areas such as infection control. These toolkits are available free of charge at www.ascquality.org and represent the collective best practices across the industry to improve patient care.

Third, we must unify our voice through the ASCA. I had the opportunity to serve on the search committee that selected Bill Prentice as the new executive director of ASCA, and I believe he is an outstanding choice to represent our community. Today, less than half of all ASCs are members of ASCA, and that figure needs to rise significantly if we are to be successful.

Fourth, we need a higher degree of active participation in the political process. Within SCA, we reference an African proverb that says: “When you pray, move your feet," meaning: it is one thing to complain about something; it is quite another thing to actively do something about it. We need more physicians, administrators and other ASC leaders to volunteer to be grassroots champions for their federal legislators – hosting site visits, connecting periodically via letter, e-mail or phone with their legislators, etc. Anyone can sign up to be a grassroots champion by visiting www.improvingsurgicalcare.com  — an ASCA staff member will follow up with you shortly to help you get started.

Fifth, we need to achieve a dramatically higher level of political giving. The ASC industry is outspent 50 to one by other segments of healthcare delivery. This figure must change in order for the ASC industry to compete effectively with the messaging from other healthcare provider segments. If the physicians, administrator and other leaders of each ASC gave a total of $1,000 each year, we could increase our political giving by 2,500 percent (25x) as a community. Consider how much each physician spends on malpractice insurance. Is $50 to $100 per year an appropriate amount to invest in ensuring that the remarkable value that ASCs provide is communicated effectively?

We stand on the threshold of a new era in healthcare, and we have the ability to contribute meaningfully to the improvement of our healthcare system — providing outstanding patient care and delivering significant savings to the system. At the same time, we face unprecedented threats to our ability to continue to provide that care and value to our patients. By increasing our focus on and investments in producing outstanding clinical outcomes and communicating effectively as a community in Washington, D.C., we can ensure that our government makes well-informed decisions that will foster our ability to provide both outstanding patient care and significant cost reductions at this critical time for our country.

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