Becker's Spine Review

55 ASC Christine Blackburn, BSN. Administrator at the South Kansas City SurgiCenter (Overland Park): I think the next three years will be pivotal for ASCs for multiple reasons in regard to aging surgeon owners. ese surgeons see inconsistent payer practice from CMS and commercial with restrictive prior authorizations and then the remov- al of the 258 CPT codes from the ASC. It's so hard to decide where to go with this information. Do we invest in more, or do we retire? Additionally, COVID-19 and all of the variants and the expense and changes that come with this. If they are close to retirement, this might be the tipping point for the physician. Can the new surgeon afford to buy into a center? Anthony Bevilacqua, MD. Surgeon of Sports Medicine & Ortho- paedic Center (Suffolk, Va.): I think the physician shortage will result in more physician assistant and nurse practitioner extenders, and the surgeons that do exist will be in surgery more. e way that will most affect the surgery center is likely by having more "flip rooms," where the surgeon can work between two rooms to get a larger case volume completed. I would also expect some centers to work longer hours some days to accommodate this. David Horace. Administrator and Owner of Bel-Clair Surgical Center (Belleville, Ill.): I do not think the aging physician population will have a significant effect on ASCs in the next three years, since we have recently added several physicians at our facilities who, instead of retiring, have decided to transition from private practice to a manage- ment services organization environment and continue to practice in the ASC setting to avoid the headache associated with the hospital en- vironment. is increases their satisfaction and that of their patients while earning technical component revenue. Timothy Kremchek, MD. Surgeon of Beacon Orthopaedics & Sports Medicine (Cincinnati): 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 busi- ness." is will allow better physician reimbursement — hence, higher motivation. Frank York. CEO of NewSouth NeuroSpine (Flowood, Miss.): With fewer physicians opting to commit the time and resources to specialty surgical training, there will be an increase in the number of patients seen per surgeon. More and more surgeries will take place in the am- bulatory setting as minimizing per-patient operative and turnover times will be necessary. Glen Silverman. CEO of U.S. Orthopaedic Partners: I think ag- ing physicians are always a concern. These physicians are typically instrumental leaders within many of the groups, they provide lead- ership and guidance to younger doctors and, in many cases, they have helped pave the way for so many that follow them. I think with effective planning you can take many of the unknowns out of the potential impact they might have in an ASC. Additionally, on a positive note, doctors coming out of fellowship today are being trained in the outpatient space and are probably much more com- fortable with it as a primary practice location versus how doctors were trained years ago. n ASC budgets for 2022: 3 new issues as delta variant surges By Laura Dyrda A SC executives are looking ahead for 2022 budgeting, but uncertainty related to COVID-19 will continue to throw a wrench in short-term strategic plans. At the Becker's Orthopedic, Spine + ASC Virtual Event on Aug. 12, three surgery center leaders discussed how they are navigating the roadblocks in planning for 2022. Below is an excerpt from the panel, lightly edited for clarity and style. Question: What is the top challenge for budget planning today? Doug Wisor, MD. CEO of National Spine & Pain Centers (Rockville, Md.): We're a private equity-backed portfolio company. We're seeing various degrees of recovery in healthcare services that can often vary between politics, whether the state is red or blue, and willingness of patients to come out for elective care. Now with the delta variant, there are various levels of vaccination and willingness to get the vaccine. The biggest challenge is getting back to baseline, which for us will be our 2019 numbers. Lianne McDowell. CEO and Administrator of South Portland Surgical Center (Tualatin, Ore.): In my area, staffing and nursing wages are very competitive. In the last couple of months, I've seen a big increase in wages for nurses. There is a lack of staffing and nursing, there is a lot of competition with the hospital benefits and wages that are really skyrocketing, not just 2 percent or 3 percent, but more like 20 percent to 30 percent increases. That is my biggest challenge going forward, not only in the rest of this year, but in 2022. First and foremost, right now as I head into the future, we are getting back up and run- ning at 100 percent capacity, and we've seen our case vol- umes return to normal. We will have to adjust for the wage increases going forward. Anna Weaver, MSN, RN. ASC Administrator of Bruns- wick Surgery Center (Leland, N.C.): For me, the biggest challenge is keeping abreast of all the CMS policies and changes, and which procedures have been added to the ASC setting. They're looking in 2022 to move some proce- dures back to the inpatient-only list. I'm sure all of us have worked throughout our careers to understand why the dif- ferent settings have a different payment structure. Looking at the increases, there was around $90 million that will be appropriated in 2022 for ASCs as compared to 2021. How does that play out? What CPT codes are we going to be able to take to an ASC without worrying about removal or setbacks? That will be a challenge ahead for ASCs and practice leaders. n

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