The U.S. Centers for Medicare & Medicaid Services (CMS) and its Innovation Center are doubling down on preventive care while striving to shift care away from the traditional acute care hospital.
For ambulatory surgery centers (ASCs), that could mean – at least in theory – more opportunities to participate in innovative payment models in the not-too-distant future.
On May 13, CMS and the Center for Medicare and Medicaid Innovation (CMMI) unveiled their “Making America Healthy Again” vision, outlining key priorities in white paper written by CMMI’s director, Abe Sutton. Specifically, those priorities are to promote evidence-based prevention, empower health care consumers and drive choice, according to Sutton.
“The Innovation Center will work expeditiously toward the future of health – building a system in which people are empowered to achieve their health goals and providers are incentivized to compete to deliver high-quality, efficient care and improve the health outcomes of their patients,” Sutton wrote in the white paper.
ASCs were not mentioned by name in CMMI’s strategy explainer.
Yet the strategic priorities laid out in the white paper, particularly the emphasis on shifting care from high-cost to high-value settings, align directly with what ASCs offer.
What’s more, the concept of choice and empowering consumers is a rallying cry of the ASC industry.
“People should … have more choice on where they receive care and who comprises their care team,” Sutton wrote. “Innovation Center models can require site-neutral payments across settings to reduce costs and reinvest hospital capacity in outpatient and community-based care through changes to certificate of need requirements.”
Thus far, ASCs have had limited inclusion in major Innovation Center programs, including bundled payment models like BPCI or population health initiatives such as ACO REACH.
Much of CMMI’s focus has centered on hospitals, physician groups and primary care networks, often leaving ASCs on the periphery.
Part of that exclusion stems from structural and policy limitations. Many CMMI models are built around total-cost-of-care frameworks, or rely on robust EHR and claims infrastructure. Those are areas where ASCs have historically had less engagement or capacity compared to hospitals.
A shift toward outpatient-centric innovation at CMS and CMMI could change that.
For instance, by signaling support for “site-neutral payments,” Sutton could be opening the door to reimbursing ASCs on a more level playing field with hospital outpatient departments (HOPDs). This could be a significant shift if adopted across more programs, incentivizing the use of ASCs for surgeries and procedures that can be safely delivered in lower-cost environments.
Additionally, the emphasis on community-based models and reducing regulatory barriers, including certificate-of-need (CON) reforms, echoes what some ASC industry leaders have already called for.
“The Innovation Center’s next phase will focus on testing models that transform the U.S. health system into one that builds healthier lives – through prevention, individual empowerment and choice and competition,” Sutton concluded.
