The Ambulatory Calculus: Competing With What You Have Now
A second outpatient migration is underway, as surgery and infusion leave the hospital outpatient department for freestanding sites that don’t earn HOPD rates. This shift is driven less by clinical advances than by who pays and who owns the site: physicians with ASC equity pull surgical cases, and payer site-of-care policies pull infusions. Health systems compete for that volume against independent physicians, payer-owned sites, and well-capitalized national platforms. Every case moved early gives up hospital revenue, and every case moved late may end up somewhere else.
In this member-led session, Strategy Catalyst leaders are joined by executives from Baptist Health, ChristianaCare, and Ochsner Health, who share how they’re competing for the surgical and infusion volume leaving the HOPD.
Member Speakers:
Phil Gaby, Executive Director of Surgical Service Lines, Baptist Health
Douglas Azar, Senior Vice President, Growth & Strategic Partnerships, ChristianaCare
Emily Lawrence, VP of Cancer Service Line and Precision Medicine, Ochsner Health
Neil Hunter, System Director of Sterile Drug Compounding Operations, Ochsner Health
Key Takeaways
Payment and ownership, rather than clinical capability, are leading the shift out of the HOPD. The first outpatient migration followed clinical capability advances. This one is driven by payer pressure and physician ownership. Physician equity pulls surgical cases into ASCs and payer steerage pulls infusions to lower-cost sites.
Baptist Health makes lower ASC rates work through ASC throughput, hospital OR backfill, and portable rates. It converted two of its most profitable HOPDs to ASCs, where cases pay about a third as much but are designed for higher throughput and efficiency. With the freed capacity, its hospital ORs can now take on more complex and robotic cases. In exchange for price relief, largely in its EDs, payers gave Baptist favorable ASC rates it can use beyond Jacksonville. Those portable rates are attractive to physician partners as Baptist plans ASC expansion outside its home market.
ChristianaCare is using an operating partner’s expertise to grow from 6 ASCs to as many as 20 by 2033. ASC deals are time-intensive and depend on due diligence, which is where Atlas Healthcare Partners comes in, along with improving revenue capture and costs. The model gives surgeons 49% ownership and clinical leadership of each center. The plan means giving up hospital outpatient revenue sooner, a tradeoff ChristianaCare accepts because moving too late could mean missing the opportunity entirely.
Ochsner Health is shifting to lower-cost infusion sites ahead of payer pressure, starting with margin-neutral drugs. Its oncology and pharmacy teams identified drugs that earn about the same margin outside the hospital and began moving them to non-hospital infusion suites, filling the freed hospital chairs with cancer growth. Ochsner now has 4 of these suites open and 3 pending, alongside 21 hospital infusion centers.