Many health systems are at various stages of migrating surgical cases from their inpatient hospital to outpatient sites of service, including ambulatory surgery centers (ASCs). Planning for surgery migration requires integration across multiple aspects of the health system, including facilities, operations, finance, staffing, and managed care contracting. What should not be overlooked, however, is optimizing the physician network, which is best addressed early in the migration planning process.
In an optimized physician network, providers are highly aligned with a health system, and the right services are available in the appropriate geographies and care settings to meet the needs of a specific patient population. Regardless of where a health system is in the surgical migration process, an optimized physician network promotes success in three distinct ways.
- A physician network that is optimized for surgical migration will have enough employed or aligned surgeons and referring physicians in network to support all new and existing sites of service. If a health system surgery migration plan includes growth in case volume to mitigate some reduction in inpatient revenue due to an outpatient shift, there must be enough surgeons and referring physicians to support that growth. Further, the location of new sites of service plays a role in evaluating the physician network. A new ASC located away from the main health system campus should have the physician network to support volume from both a surgeon and referring physician perspective.
- Many surgery migration plans will include the expansion or addition of sites of service, such as an ASC. There may be opportunities for partnership with independent physicians to bring an ASC online in the health system via an alignment model such as a joint venture. Health systems that have optimized their physician network early in the surgery migration process will have a clear understanding of partnership opportunities that may be mutually beneficial for physicians and the system. This also allows systems to be selective in choosing partners who will support care objectives.
- Surgical migration plans should account for potential gaps in call coverage as surgeons increasingly practice in off-campus settings like ASCs. Depending on the distance and operating hours, the gap could be significant enough to jeopardize the essential coverage for emergency care. Some specialties, such as orthopedics and gastroenterology, may have more significant call burdens compared to other specialties and require careful planning to avoid gaps in the call panel. And as more acute cases begin to migrate to outpatient settings in the future (e.g., cardiac catherization), the need to plan for additional specialty coverage will increase.
Health systems that have a proactive, well-defined strategy and approach for the development of their physician network should have a stable, optimized physician network in place before migration occurs. This will allow the system to establish appropriate physician partnerships and solidify coverage to support the shift in cases to new or existing outpatient sites of service.
As the health system plans for migration, it should have a complete understanding of:
- Its physician network.
- How the network is positioned for surgical volume to move to the outpatient sites of service.
- Where vulnerabilities for specialties and/or sites must be addressed.
Published December 15, 2021