Becker's ASC Review

16 Thought Leadership How the impending physician shortage could threaten independent surgery center ownership By Patsy Newitt T he U.S. is expected to reach a shortage of 37,800 to 124,000 physicians by 2034, and more than 2 of 5 active physicians will be older than 65 in the next decade. is impending physician shortage, paired with increasing industry consolidation, has some ASC leaders worried the physician-owned busi- ness model of ASCs will be jeopardized. "As the generation of independent surgeons that founded many ASCs 20 to 25 years ago approach retirement, there may be fewer sur- geon investors available to replace them," Scott ellman, MD, surgeon at Lawrence (Kan.) Plastic Surgery, told Becker's. is is exacerbated as more physicians are be- ing employed by hospitals. By the end of 2020, nearly 70 percent of physicians reported being employed by hospitals, with a steady accelera- tion in the latter half of the year. Dr. ellman added that hospital-employed surgeons could be pressured to partner with systems and develop strategies that allow for employed surgeons, rather than independent ones, to share ownership in ASCs. Additionally, some ASC leaders have seen an increasing number of independent practices being sold to hospital systems and redirect- ing outpatient procedures to hospital-owned surgery centers. "I think the pandemic severely affected the sole-practice physicians, as many of them sold to hospital systems to cut their losses and sustain their careers," Trey Sampson III, ad- ministrator of Newport Beach (Calif.) Surgery Center, told Becker's. ere are also CMS and commercial payer changes that have made many physician owners question the financial viability of their ASCs. "Surgeons see inconsistent payer practice from CMS and commercial with restrictive prior authorizations and then the removal of the 258 CPT codes from the ASC," Christine Blackburn, BSN, administrator at the South Kansas City SurgiCenter in Overland Park, told Becker's. "It's so hard to decide where to go with this information. Do we invest in more, or do we retire?" COVID-19 was the tipping point for many physicians. About 25 percent of physicians have made plans for early retirement dur- ing the pandemic, according to a Medscape survey. With these retirements, Ms. Blackburn is un- sure if newer surgeons will be able to buy the centers. Fewer physicians coming out of medi- cal school are choosing private practice be- cause they graduate with large medical school debt, and hospitals can offer signing bonuses to relieve some of that financial pressure. Christina Holloway, RN, the administrator of Ambulatory Surgery Center of Bala Cynwyd (Pa.), expects ASC funding to also be affected by the physician shortages. "Our facet of healthcare will not only lose providers for the patient populations served but also supportive funding," she told Becker's. "When taking these future complications into account, along with the potential upcoming CMS amendments to elective procedures, the next three years will truly navigate how outpa- tient services will suffer or survive as a viable option for care." Many ASC leaders are worried about this de- cline of physician ownership — will indepen- dent ASCs be able to keep costs low? "Physician ownership preserves efficiency, is a great recruitment tool and keeps costs down for our patients," Dr. ellman said. n Personalities as important as resumes when hiring, say ASC leaders By Marcus Robertson A SC jobs offer a few advantages when compared to hos- pital employment. One of them is the often close-knit work relationships ASC employees tend to have with each other, since ASCs are typically smaller than hospitals. Keeping that healthy dynamic intact is critical, according to Benita Tapia, RN, administrator, and Andy Ball, CEO, both of Beverly Hills (Calif.) ASC Venture, a Cedars-Sinai affiliate; and Tiffany Jewell, BSN, RN, clinical director of Columbus, Ind.- based Wellspring Pain Solutions and Columbus Pain Institute. Each of them shared their strategies with Becker's ASC Review. Question: What do you do to maintain a positive culture as you hire new people? Ms. Jewell: When we interview our [prospective] employ- ees, obviously we're really concerned about your skills, but more than that, we're really small — so getting the wrong person in here with the wrong attitude is detrimental. So as we're interviewing, we interview personalities. Q: Are there any red flags in terms of being able to define somebody's personality during that interview process? TJ: This is going to sound kind of silly, but if they can't smile in their interview, we watch for those things. We watch for their body language — do they make eye contact? Simple things like that. Ms. Tapia: [We like to] bring them in for half a day, or a day, so that they can meet the people they're working with. They can actually see what goes on because when you take on a new job, you want to make sure you're working with people you can relate to. Mr. Ball: You can have the best resume in the world, and the [prospective] employee can interview very well, and then they turn up and it's just not a good cultural fit, or they're not quite what they said. You just have to be pre- pared to learn from those mistakes. n

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