Becker's ASC Review

12 THOUGHT LEADERSHIP Can ASCs save healthcare? By Laura Dyrda O rthopedic surgeons think ASCs are saving the specialty amid high consolidation and the movement to value-based care. Can ASCs also save healthcare? Orthopedic surgeons have the reputation of wanting to remain autonomous and operate their own practices instead of becoming hospital employees. As the costs and risks associated with owning physician practices increased during the pandemic, surgeons who had surgery center ownership were in a better position to stay independent because they had the additional revenue stream. "Along that concept of physician interest, the ASC may promote increased surgeon autonomy in their practice," said Kern Singh, MD, co-director of the Minimally Invasive Spine Institute of Midwest Orthopaedics at Rush in Chicago. "As large hospital systems continue to expand through acquisition of private groups, the autonomy of the surgeon in the hospital faces increasing resistance. Surgeon ownership of outpatient surgical centers provides an avenue for enterprising physicians to take ownership of their patient care and collections with less administrative resistance." e effect of consolidation on access to care and price of care is well-documented. In markets with fewer independent physicians and provider options, prices are higher, and there is less access to care. Communities with more independent physicians and multiple options for care typically have lower healthcare costs and insurance premiums to stay competitive. Patient satisfaction is also higher in markets with less consolidation. e surgery center is also becoming a more valuable component of the healthcare system because overall cost of care is lower at ASCs than hospitals, and in some markets insurers and employers are driving cases there. e movement could be expedited by a focus on risk-based contractive and value-based care. Patients who undergo the less-invasive surgical techniques in ASCs have less of their anatomy disrupted and are more likely to recover quickly. "e most important trend at this time in healthcare saving orthopedics is the transition to outpatient surgical care whenever ASCs' biggest enemies to patient care By Patsy Newitt S upply chain issues and CMS policies are two of the big obstacles ASCs face in providing patient care. Seven ASC leaders joined Becker's to dis- cuss their biggest enemies in patient care. Question: What is ASCs' biggest enemy in providing patient care? Editor's note: Responses were edited lightly for length and clarity. Dianna Reed. Administrator of Sani Eye Surgery Center (Templeton, Calif.): Our biggest enemy is not being able to purchase supplies — both pharmaceuti- cal and surgical packs, etc. — at a com- petitive price point. It is very difficult to compete, especially during COVID-19, for personal protective equipment and supplies against large hospital surgery centers who have a larger buying power. Staffing can be difficult for registered nurses and certified registered nurse anesthetists since we are only open one day a week, but I have resolved this by paying upwards of $25 per hour more than local hospitals. is has helped us attract per diem staff who only wish to work one day per week. Another downside to being an ASC is the reim- bursement from insurance companies. We are paid a fourth of what a hospital surgery center is paid and our costs are actually more. Cherise Brown. Administrator of Andover (Kan.) Ambulatory Surgery Center: One of the biggest hurdles with an ASC is the patient's general health and not qualifying for an ASC. If a patient has a complicated medical issue or prior health issues, an ASC is less likely to take the patient. Another issue, in the rare event that a complication should arrive during the surgery, the patient may have to be transferred to a hospital. David Horace. Administrator and owner of Bel-Clair Surgical Center (Belleville, Ill.): Biggest enemy in providing patient care is greedy medi- cal supply manufacturers and vendors that are squeezing the life out of ASC margins as ASC volume rebounds from COVID-19 decline. Cathy McCue, MSN, RN. Administra- tor of Uropartners Surgery Center (Des Plaines, Ill.): CMS supports hospitals over ASCs due to a strong American Hospital Association lobby — even though from a value perspective, ASCs provide a much more efficient model for excellent care at a lesser price point. ASCs also have less infections as ASC patients' medical and surgical history can be thoroughly reviewed prior to the surgical date (as all cases in an ASC are elective), and ASCs are limited to an an- esthesia score of l and ll (sometimes lll). I think the future will be brighter if the hospitals perform all the emergent cases and operate on the high-risk patients, leaving the lower-risk patients for the ASCs, as well as CMS approving more reimbursements (I may be dreaming). Andres Duran. Administrator of Brownsville (Texas) Surgery Center: a. Staffing b. Limited-service lines c. Quality-control concerns Barbara Clancy-Sweeney. Administra- tor of Gastroenterology & Hepatology at omas Jefferson University (Phila- delphia): Capital venture groups buying up practices and opening up ASCs. Cindy Vasquez, RN. Administrator of Central California Endoscopy Center (Fresno): Appropriate and frequent com- munication with the patient and family members has been our greatest challenge in recent years. Prior to COVID-19, fam- ily members were asked to remain in the center throughout the patient's visit in order to ensure that communication was had with the patient and family members every step of the way. Not allowing for the family members to be at the bedside made for increased patient anxieties, suboptimal communication with family members and instructions less under- stood. Text messaging helps with those that are tech savvy, but there is still a population that requires more direct communication. Unfortunately, they are oen not available to communicate with. We look forward to bringing our family members back into the center soon. n

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