Becker's ASC Review

24 ASC MANAGEMENT Tough places to build new ASCs By Laura Dyrda A SCs are typically the perfect example of high-value healthcare because centers provide quality care at a lower cost than hospitals. But ASCs aren't thriving, or even welcome, in some places across the U.S. Most ASCs are for-profit facilities that de- pend on a steady stream of patients with either Medicare or commercial insurance who need elective surgery. Surgery centers don't have the same funding sources as hos- pitals or the responsibility to care for all patients, and as smaller facilities, they don't have leverage to dictate rates during payer contract negotiations. Rural areas are tough places to thrive as a surgery center because the population is spread out and patient flow is inconsistent. Farmers oen don't have health insurance or have high-deductible health plans and are reluctant to foot the bill for elective surgery until the condition is extremely ad- vanced. In 2020, 95.4 percent of new ASCs were opened in urban areas and 4.6 percent in rural areas, down from 7.1 percent of new ASCs opened in rural areas in 2015, ac- cording to MedPAC's report to Congress re- leased in March. It's no surprise that states like Vermont, West Virginia, Iowa, Ken- tucky and Alabama have among the fewest ASCs per capita. Compounding the challenges of rural ar- eas are certificate-of-need policies, which require physicians to obtain approval to open or expand ASCs. ere are 35 states with some sort of certificate-of-need re- quirement, including the five states listed above. Hospitals oen challenge ASCs in certificate-of-need states, arguing the com- munity doesn't have a need for more operat- ing rooms and competition from the ASC would threaten the hospital's existence. For example, West Des Moines, Iowa-based UnityPoint Health is also challenging a medical group's plans to open two new cardiac catheterization labs in its ASC. Or- thoIllinois also spent a year batting back opposition from Beloit (Wis.) Health Sys- tem to develop a $14 million surgery center. On the other hand, places with the most ASCs are also challenging. Florida and Tex- as both have around 450 Medicare-certified ASCs, and California has more than 800, with market saturation in some cities. It's tough for ASCs to compete with each other for surgeons and cases, especially when in- surers narrow networks and ratchet down contracted rates. Finally, markets with strong health systems and powerful payers, including those with little payer competition, are challenging for ASCs. Insurers spend the same resources to contract with hospital systems as ASCs despite the vastly different sizes of each or- ganization. It's more efficient for insurers to focus on hospital contracts than surgery center contracts. New York is one state that traditionally has been a challenging place to open new surgery centers, but more have been approved in recent years.n Massachusetts ASC nurse agrees to plea deal in fentanyl- tampering case By Patsy Newitt A nurse from an outpatient vascular surgery center in Berkley, Mass., has agreed to plead guilty in federal court to tampering with a consumer product, fentanyl intended for a patient, the Justice Department said March 4. Hugo Vieira, 41, is charged with removing fentanyl from vials for patients who were undergoing or recovering from surgery while working at the ASC and a Massachusetts hospital from December 2018 to January 2019. According to the charging documents, Mr. Vieira replaced the fentanyl with saline — 60 tampered vials were identified at the ASC and two vials at the hospital. Mr. Vieira agreed to plead guilty to one count of tamper- ing with a consumer product. The charge of tampering with a consumer product carries a sentence of up to 10 years in prison, three years of supervised release and a fine of up to $250,000. n Colorado surgery center, pain clinic to close amid staff shortage By Patsy Newitt R edlands Mesa Surgery Center and Colorado Injury and Pain Specialists in Grand Junction, Colo., will soon close their doors, The Grand Junction Daily Sentinel reported March 26. The two businesses are in a building owned by Toledo, Ohio-based Deca Health. Deca Health "blindsided" staff at both businesses March 8 with an announcement that the surgery center will close April 1, with the pain clinic to fol- low April 8, according to the Sentinel. "The onset of COVID created a national crisis of shortage of health care workers and consequently burgeoning costs. For more than two years, we subsidized [Colorado Injury and Pain Specialists] to maintain care for our patients," Deca Health President William James told the Sentinel. n

• Cover