Becker's ASC Review

32 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 opera- tions. e World Health Organization classi- fied 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 infec- tion control as a result, and school closures due to COVID-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 success- ful veteran surgeon. ASCs are at risk of losing revenue-drivers if longtime owners opt to retire early instead of weathering the long-term effects of COVID-19 on their practices and businesses. 3. As the value of ASCs increases along with operational costs, more surgery center own- ers 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 organiza- tions for referrals and payer contracts, despite being high-quality, low-cost providers. Nearly 70 percent of physicians reported being employed by hospitals or corporations at the end of 2020, according to a June 29 Avalere re- port, including 11,300 physicians who became employed by corporate entities in the last six months of the year. 4. Inconsistent payer policies mean physi- cians 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 announc- ing 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 num- bers last year. Health systems can offer large bonuses to sign new nurses and administra- tive 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 of- fer professional growth as larger organizations do, leaving ambitious talent on the table. n 'This is a time for ASCs to thrive,' one surgeon's outlook on the looming physician shortage By Patsy Newitt M ore than 2 of 5 active physicians will be older than 65 in the next decade, but one surgeon said he thinks this could be a benefit for practicing physicians. Timothy Kremchek, MD, is a surgeon at Cincinnati-based Beacon Orthopaedics & Sports Medicine. He spoke with Becker's ASC Review about how he thinks the aging physi- cian population will affect the ASC industry. Editor's note: The responses were edited lightly for length and clarity. Question: How do you predict the aging physician population and physician shortages will affect the ASC industry in the next 3 years? Dr. Timothy Kremchek: I think the physician shortage is going to swing to the advantage of the physician. With higher competition, many physicians are fighting for new business, especially "good business." This will allow better physician reimbursement, hence, higher motivation. As there is a shortage and more physicians age, the one thing they want is efficiency. Time is of the essence. This is a time for ASCs to thrive. Multiple rooms for surgeons and ef- ficient use of staff and the rooms will allow more cases to be done and still allow the surgeon more time away. Surgeons will pull away from the slow-moving bureaucratic hospital as they can find more of the things professionally they want to do in a far easier, efficient, streamlined system — the ASC. In competitive areas, the decrease in physicians will only aggravate the patient base, as many are used to expedient, same-day care. That no longer will be the case. Q: What novel surgical technique has had the most sig- nificant impact on your practice? TK: By far, other than advances in arthroscopic surgery, the ulnar collateral ligament reconstruction of the elbow and the advances in rehabilitation with that procedure have been a game changer. Being able to allow these youngsters to continue their careers, and in some cases fulfill their life long dreams, has been very rewarding. n

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