Becker's ASC Review

20 Thought Leadership ASC budgeting for 2021: 6 execs outline their strategy By Laura Dyrda A SC administrators had to change plans during the pandemic aer some temporarily closed or lowered procedure volume to conserve resources and stem the spread of COVID-19. Here, six administrators outline their approach and key considerations for this year's budgets. Linda Bravyak, RN, NHA, CASC. CEO of Pocono Ambulatory Surgery Center (Stroudsburg, Pa.): One of the biggest challenges we see is increased labor cost for staffing for the entire COVID-19 testing process. is process not only includes the actual swab testing of the patient, but all the other extra work that goes along with it. We have been tracking the actual time it takes for all the steps needed to do it here at the center such as: • Preoperative phone calls to schedule the testing for the patient • Actual testing • Postoperative test results phone calls • Making up the patient packet for the tests • Adding patient labels to the paperwork for day of testing • Printing all the requisitions out for the lab • Follow up with the lab for the test results • Additional calls to the center for directions, changing their times • Ordering of supplies for the testing Add the screening of patients, physicians, staff and vendors at the door, and that is an additional cost of a staff member. Also, we do daily calls to the lab for the specimen pickups. e other thing to consider is the actual budgeted volume versus the trending reports from previous years. Doug Wisor, MD. CEO of National Spine & Pain Centers (Rockville, Md.): We considered 2019 to be our baseline for the 2021 budget cre- ation for a couple of reasons. ere were several puts and takes in 2020 with COVID-19. Using 2019 as the baseline as our budget barometer is reasonable, whether that be on a per provider or per center productiv- ity basis. As we add providers and centers we'll adjust, but we are going to treat 2020 as an outlier and budget off of 2019 volumes. What creates a challenge for platform-level companies like ours, that operates out of 22 ASCs in 11 states with approximately 125 physi- cians, is the confusion of which industry reports to follow as the credible benchmark. We are a private equity-backed platform and follow not only Becker's updates, but also the Marwood Group reports closely, as well as the IQVIA benchmark data and Cohen industry report. More oen than not, we have to extrapolate pain management procedure benchmarks from orthopedics or neurosurgery data. Dis- secting outpatient musculoskeletal pain from those industry reports collected from hospital outpatient departments isn't always an easy apples-to-apples comparison. Net-net, we see 90 to 95 percent of historical baseline in regards to total encounter volumes is where the industry is at today. Yet, new patient encounters seem to be lagging slightly behind. It appears that estab- lished patients are comfortable with a known entity provider, but new patients have more consumer confidence concerns about seeing pro- viders they have not established a relationship with yet. We originally envisioned 5 percent growth over 2019 in 2020, and we will use that as a volume barometer to finalize expectations for this year with the caveat of consumer confidence in the vaccine and potential impact of unemployment on patients' disposable spending. Tina Piotrowski, BSN, RN, CASC. Administrator of Cooper Ridge Surgery Center (Traverse City, Mich.): Budget planning for 2021 will be a challenge for ASCs and will require several scenario models based on the unpredictability of the COVID-19 pandemic. I anticipate continued supply cost increases, particularly with personal protective equipment, as the disruption in the supply chain carries over to 2021. In addition, labor costs remain higher as centers staff for COVID protocols. Expanded cy- ber liability is also being analyzed due to more remote working for some positions and the increase in cyberattacks on healthcare. Jacob Rodman. CEO of Raleigh (N.C.) Neurosurgical Clinic: To be honest, 2021 was one of the more difficult years to budget with so many unknowns, especially during the first quarter. We are approach- ing it through an overly conservative lens in hopes we far exceeded our expectations. We closed 2020 down roughly 15 to 20 percent and anticipate that trend to continue into the early part of 2021 with an eventual rebound toward the summer months. Sam Romeo, MD. General Partner of Tower Health & Wellness Center (Turlock, Calif.): e challenge is the potential of a Biden ad- ministration's impact on social and political restrictions on businesses. We will pray that with the advent of the vaccine, the national political scene and our California governor will reduce the restrictions and fear mongering and permit us to return to normal. Todd Evans. CEO of Orthopaedic Institute of Dayton (Ohio) and Executive Director of Greater Dayton Surgery Center: Budget plan- ning for 2021 was obviously more difficult than usual. I think one of the key components was flexibility. e ability to flex your budget and handle variations in volume/expense is going to be critical this year. Another key is having a solid understanding of your margins. We found that being able to flex our case mix to maximize profits prior to a shutdown and coming directly out of the shutdown was critical. Being able to understand exactly what your margins are on each individual case allows you to make better decisions when every case counts. n

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