Becker's ASC Review

7 ASC MANAGEMENT 10 predictions for ASCs in 2022 By Laura Dyrda C onsolidation, payer policies, nurse shortages and COVID-19 will con- tinue to loom large for surgery centers this year. Here are 10 predictions: 1. Physicians will have more power and be driven to develop new ASCs or join an exist- ing center as a highly efficient site of care. "As there is a shortage and more physicians age, the one thing they want is efficiency. Time is of the essence. is is a time for ASCs to thrive. Multiple rooms for surgeons and efficient 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," Timothy Kremchek, MD, of Cincinnati-based Beacon Orthopaedics & Sports Medicine, told Becker's. 2. Large ASC chains will further consolidate, with even the largest chains needing new ways to spur quick growth through acquisi- tions and health system partnerships. ere will likely be more acquisitions like Dallas- based United Surgical Partners International's $1.2 billion deal for SurgCenter Development finalized in December. 3. Commercial insurers will try to drive more cases to the ASC by narrowing guidelines for outpatient procedures. However, the potential higher volume won't guarantee sustainable pay rates for procedures. Prior authorizations will also be big roadblocks for ASCs, especially as more complex cases come into the centers. 4. Private equity will make more inroads with midsize physician groups and large ASC chains. "A majority of ASCs are owned by physicians. Private equity and venture capital groups are assessing deploying major capital investments in ASCs, especially as insurers and CMS are transitioning their more com- plex, high-cost surgical procedures to ASCs due to cost savings with safe, convenient and quality results," said Joe Peluso, administrator of Aestique Surgery Center in Greensburg, Pa. 5. e relationship between hospitals and physician-owned ASCs in many communi- ties will grow more contentious as the two facilities compete for physicians, outpatient surgeries and nurses. e nursing shortage nationally compelled many health systems to pay large bonuses for new nurses, or high rates for traveling nurses, luring nurses away from the ASC. However, long hours at the hospital and pandemic-related burnout also drives nurses to the outpatient setting, where they have a more reliable schedule and do not treat COVID-19 patients. 6. Surgery centers will be required to collect more clinical and cost data as the industry pushes for value-based care and price trans- parency. ASCs with the right technology and infrastructure to provide this information quickly and use it to promote their services will be in the best position to succeed. 7. Surgeon owners nearing retirement may decide to take the plunge early instead of facing new challenges from COVID-19 and payer policies. "ese surgeons see inconsis- tent payer practice from CMS and commer- cial with restrictive prior authorizations and then the removal 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?" said Christine Black- burn, administrator of South Kansas City SurgiCenter in Overland Park. 8. ere will be more nontraditional methods for driving case volume, including direct-to- employer contracting and digital marketing to the consumer. Surgery centers will also invest more resources in boosting the patient, and surgeon, experience. 9. Vendors will increasingly devise ASC- specific strategies to target independent surgery centers, which still comprise the majority of ASCs in the U.S. Success with the ASC strategy will be key for orthopedic device companies in particular as more total joint replacements and spine surgeries are performed in ASCs. 10. Surgery center owners are investing in growth and expansion, and will need ad- ditional financing. "Our partners have made significant sacrifices over the past two years to keep our staff on board, and we need to get as close to normal as possible. Because of the major investments we plan to make, we will be relying on financing options more heavily than in the past," said Alfonso del Granado, administrator of Covenant High Plains Sur- gery Center in Lubbock, Texas. n ASC disputes payer's conclusion that spine cases should have been in the hospital By Laura Dyrda T he Center for Pain Management remains out of network with Blue Cross and Blue Shield of Minnesota after the payer terminated its contract over safety concerns in October. The practice, which includes multiple locations and an ASC in Alexandria, Minn., disputed Blue Cross' claims and wants to resolve the issue, according to a Jan. 19 report from the St. Cloud Times. Blue Cross' review examined 20 elderly patients, 19 with spine pain, who the payer said should have undergone their treatments in the hospital. The patients received transforaminal epidural steroid injections or radiofrequency ablation without complications. Blue Cross also accused the physicians of unnecessarily inflating the cost of care with spinal injections ahead of treatment. Mike Hatch, attorney for the Center for Pain Management, told the St. Cloud Times the practice used mild anesthesia because transforaminal epidural ste- roid injections and radiofrequency ablations include painful needle sticks. Blue Cross reported the Center for Pain Management to the Minnesota Depart- ment of Commerce and FBI, but neither agency commented on the review. n

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