Becker's ASC Review

42 Thought Leadership The biggest threats to ASCs today By Laura Dyrda A SCs have faced multiple challenges since the pandemic began in March 2020, from limited elective procedures and temporary center closures to staff furloughs and high personal protective equipment costs. Physician owners and operators are looking ahead to future growth and see that a few big threats to independence remain, based on conversations with more than 25 surgery center leaders in the last 60 days. 1. COVID-19 surges and new variants making their way across the U.S. threaten ASC operations. e World Health Organization classified a new COVID-19 variant, mu, as a variant of concern Aug. 30, and administrators have taken notice. Surgery centers are continuing expensive protocols for extra PPE and infection control as a result, and school closures due to CO- VID-19 outbreaks are further exacerbating staffing shortages because vital team members must take temporary leave to stay with their children. 2. Early retirements for founding physicians leave a gap in ASC ownership that isn't easily filled by new investors. ere are fewer early-career physicians with the ability to invest in ASCs today than in the past, especially at the level required to replace a busy and successful veteran surgeon. ASCs are at risk of losing revenue-drivers if longtime owners opt to retire early instead of weath- ering the long-term effects of COVID-19 on their practice and business. 3. As the value of ASCs increases along with operational costs, more surgery center owners are tempted to sell. Hospitals, private equity firms and insurers are all hunting for ASC deals and willing to pay top dollar. Consolidation in healthcare raises prices and oen means owners lose autonomy to make decisions about their centers. e shrinking market also makes it tougher for independent centers to compete with large local organizations for referrals and payer contracts, despite being high-quality, low-cost providers. Nearly 70 percent of physicians reported being employed by hospitals or cor- porations at the end of 2020, according to a June 29 Avalere report, including 11,300 physicians who became employed by corporate entities in the last six months of the year. 4. Inconsistent payer policies mean physicians and ASCs have to spend more resources on the revenue cycle process. Surgeons and centers are reporting: • More prior authorization requirements for surgery • Increased denials on previously covered services • Procedures, such as lumbar spinal fusions, covered by some payers but not others CMS also has ASCs on edge aer announcing plans in July to remove 258 procedures from the ASC payable list in 2022. Surgery center owners are now wary of spending the resources to add newly covered procedures if CMS reverses their decision aer one year. 5. ASCs don't have an answer to the staffing shortage plaguing healthcare organizations aer nurses and staff exited in large numbers last year. Health systems can offer large bonuses to sign new nurses and administrative staff, while ASCs still rely on consistent, weekday-only scheduling and positive culture as the hook to draw in new talent. Surgery centers also do not have the same ability to offer professional growth as larger organizations do, leav- ing ambitious talent on the table." n The 'many hats' of ASC leadership: How leaders balance multiple roles By Patsy Newitt ASC leaders must juggle multiple roles and responsi- bilities to keep their centers running. Andrew Lovewell is the administrator of the Surgical Center at Columbia (Mo.) Orthopaedic Group. He spoke with Becker's ASC Review on the ideal leader- ship model. Question: What's the ideal leadership model for ASCs? Andrew Lovewell: The difference with an ASC ver- sus other healthcare organizations is that they tradi- tionally wear more hats. Many people think ASCs are easier to manage because they are smaller, there's less staff and most ASCs perform niche procedures. This assumption couldn't be any more wrong! The leadership team has to take care of the HR, privacy and compliance, policies, regulatory, quality improve- ment, scheduling, contracting, etc. Most other or- ganizations have multiple people for all those roles, whereas an ASC might have a leadership team that consists of three to four people. The world we live in isn't getting any easier for leaders anywhere, but that's exceptionally true in the ASC space. On one hand, we have a lot of procedures shifting to the ASC environment and providing an opportu- nity for increased volumes and revenue. However, the leaders of the ASC have to assure that things are done safely and efficiently for both patients and physicians. We have to create an environment of safety and security so patients don't feel like they are getting something less than what they may have received at a hospital or any other facility. Leaders in the ASC world have a big job. They traditionally get bombarded with every single type of issue that happens in their facility, and they set the tone for the organization. I can tell you based on previous experiences that a leadership team for an ASC can dramatically shift the culture of both staff and physicians. I am fortunate that the leadership team at our facility is outstanding. We have a very supportive board of physicians that have given the leadership team a lot of autonomy to assure that things are done the right way. On top of that, our service line leaders in nursing, materials management and our business office are all excel- lent. There's this philosophy that if you give people the resources they need, the education and training to be successful and provide them with some au- tonomy to do what they are good at, they are going to be successful — it's true! n

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