Becker's Spine Review

53 ASC The biggest threats to ASCs remaining independent 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. 1. COVID-19 surges and new variants making their way across the U.S. threat- en ASC operations. e World Health Organization classified a new COVID-19 variant, mu, as a variant of concern Aug. 30, and administrators have taken no- tice. Surgery centers are continuing expensive protocols for extra PPE and in- fection 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 successful veteran surgeon. ASCs are at risk of losing reve- nue-drivers if longtime owners opt to retire early instead of weathering 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 cen- ter 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 cen- ters 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 corpora- tions 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 pro- cedures 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 its decision aer one year. 5. ASCs don't have an answer to the staffing shortage plaguing healthcare orga- nizations 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, leaving ambitious talent on the table. n Patients want the 'precision of robotics,' Florida ASC administrator says By Patsy Newitt I n the new "shopping" era of healthcare, some ASC leaders feel surgical robots are a way to stand out. Armando Colon, CASCC, is the privacy and compliance officer at the Day Surgery Center in Winter Haven, Fla. He spoke with Becker's ASC Review on the important considerations when onboarding surgical robots. Question: On a scale of 1-10, how important are surgical robots to ASC growth? Why? Armando Colon: Our vision is to design a robotic program that enables surgeons to perform minimally invasive surgery with en- hanced visualization and accurate control. We would scale 10 on how important are surgical robots. We push for a better medical ecosys- tem — from the patient journey, to the operat- ing room staff experience, to improved train- ing, procedures and outcomes. We champion a healthcare industry where patients in every community can expect and have access to the most advanced quality care at a predictably lower cost with the best possible results. Robotics is an important consideration when planning capital expenditures. Cost of surgi- cal robots, cost of operating a robotic case — which includes but is not limited to dispos- ables, supplies and staff — vs. the reimburse- ment to obtain an adequate return on invest- ment are factors to be considered. Patients are looking not only for safety and value but advanced technology and the pre- cision of robotics when choosing a surgical facility. With this being said, the most success- ful outpatient total joint or spine programs are heavily reliant on physician buy-in and involvement, in addition to well-thought-out protocols and an engaged anesthesia part- ner. We can proudly say that the physician's involvement and engagement is there, as well as the best implementation protocols. For ASCs, having a robot in the operating room can mean that more procedures can be per- formed with fewer complications and higher levels of patient satisfaction. n

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