Constantly seeking innovation: 3 key thoughts on Marshfield Clinic Health System's growing ASC presence

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Healthcare’s latest technological advancements have allowed surgery centers to perform higher acuity cases for a multitude of patients, and payers across the board are beginning to understand the benefits of ambulatory care centers. Since October 2015, Marshfield (Wis.) Clinic Health System, one of the largest U.S. not-for-profit private multispecialty group practices, is continuing to push the envelope by strengthening its outpatient strategy. MCHS has four multispecialty ASCs throughout the state.

“We have been in the ASC space for decades and we have the sixth largest ASC in the nation, which may lead people to wonder why we are expanding,” says Susan Turney, MD, MCHS CEO. “The key is technological advancements with changing reimbursement. By moving patients from the inpatient to ASC setting, they can recover beyond 24 hours [at our centers] and we can reduce the overall cost of care.”

Here are three key points on the group’s expansive outpatient strategy.

1. Robotic surgery has allowed MCHS to boost its offered services and perform more complex cases. The MCHS ASC performed its first outpatient robotic hysterectomy in October 2015, and has performed nearly 99 of these cases to date. Narayana Murali, MD, executive director and chief clinical strategy officer of Marshfield Clinic, is primarily responsible for leading the practice’s clinical care delivery and notes Marshfield was able to perform more cases because of robotic surgery’s advancements in recent years.

Merely a month later in November 2015, the practice performed its first outpatient total hip replacement with the clinic boasting 193 completed THRs so far. Additionally, Marshfield Clinic most recently performed its first outpatient robotic nephrectomy and has completed six of these procedures.

2. The health system had to do a substantial amount of legwork to transition these cases to the outpatient setting. Dr. Murali says the practice first identified which procedures it could effectively and safely perform in the ASC and developed the appropriate processes for patient care and monitoring each procedure’s results. The ASC has various teams charged with overseeing different entities to ensure every aspect of care runs smoothly and patient safety is a top priority.  

“We have service line experts who review the standards of care and fine-tune these standards,” Dr. Murali notes. “[Our ASC strategy] is a success story for the health system, for the patient and for the payers. It is good for the families too who are often burdened by post-op care.”

3. Marshfield Clinic Health System has its own health plan which allows its ASCs to provide care to a great number of patients. However, the practice is striving to provide care for the Medicare and Medicaid fee-for-service population, segments that Dr. Murali says would stand to benefit the most from outpatient surgery.

“In the areas that we provide care here in Wisconsin, there is a predominantly older population that we need to cater to,” he says. “We are also trying to get on board with larger payers and expand our presence.”

Dr. Turney adds that the practice is negotiating with larger payers to cover these bundles of service and is also strengthening its hospital presence.

“We have had issues in our negotiations with large payers because we are asking for coverage that currently does not fit into their ideal business model” Dr. Turney says. “When we do our bundle contracting on a larger scale, we anticipate getting over these bumps.”

MCHS continues to strategize on new ways to bolster its outpatient strategy and has made significant progress to date. Compared to the first quarter of fiscal year 2015, the MCHS had a 333 percent increase in the number of patients who can have these procedures at their facility.

“Our philosophy is that we are always looking for innovation to ensure we provide the right care, for the right patient, by the right provider at the right site of service. Whether we accomplish this with technology, extending the recovery period or expanding our ASC service,” Dr. Turney says. “We aim to be innovative in our care approach to ensure outcomes are as good as or improved upon a traditional setting [such as a hospital].”

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