Becker's ASC Review

10 ASC MANAGEMENT Can ASCs handle the boom in case volume? By Patsy Newitt A SC surgery volume is projected to grow 25 percent in the next decade, according to an analysis from Sg2 Healthcare Intelligence, but it's unclear whether ASCs will be able to ac- commodate these new cases with rising staff and supply costs. ASC costs must remain low for the centers to remain financially viable, a difficult feat amid a 40-year inflation apex. Staffing costs are soaring with a tightening job market, with many employers setting aside an average of 3.9 percent of payroll this year for wage increases, according to e Wall Street Journal. Surgery centers spend on average $2.2 million on employee salary and wages, about 21.3 percent of net revenue, according to the VMG Health's "Multi-Specialty ASC Benchmarking Study." e rising cost for staff is creating a massive financial burden for many ASCs. "e inflationary market pressure on all of our collective purchasing power and the 'great reshuffling' have created extreme wage competi- tion and a hyper-competitiveness within the market," Andrew Wade, CEO of OrthoSC in Myrtle Beach, S.C., told Becker's. Nurses are among the most difficult staff members for ASCs to recruit, and these shortages are expected to get worse. According to a May 11 McKinsey report, the United States could see a deficit of 200,000 to 450,000 registered nurses available for direct patient care by 2025. e U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses nationwide by 2030. With a worsening nurse shortage, ASCs could have trouble at- tracting patients and accommodating the expected increase in case volume. According to an April 5 poll from the Medical Group Management Association, a lack of nurses lowers staff morale and leads to patient dissatisfaction. In a time when patients comparison shop for healthcare, they have high expectations. During medical visits, they expect to see ample staff for such tasks as setting up referrals and scheduling. e cost of retaining and recruiting nurses isn't the only budget con- cern of ASC leaders, who oen have to get creative to keep supply costs down. "I spend a lot of time trying to identify waste and cost savings," Helena Levenson, senior clinical consultant of ambulatory surgery at Cardinal Health, told Becker's. "I can help facilities make more cost- effective custom packs, or if they are currently using them, identify waste in the packs, or products we can add to the packs to make them more effective and efficient." And while CMS raised ASC payment rates by 2 percent for 2022, many leaders don't expect the rate to cover the costs. "Reimbursement is a huge issue that ASCs keep facing. As we see the push for single-payer healthcare, it's getting harder and harder to negotiate good rates with insurance companies," Allison Stock, BSN, RN, administrator of Lenox Surgery Center in Lenox Township, Mich., told Becker's. n Same surgery cost nearly 20 times more in HOPD than ASC in California By Patsy Newitt A retired orthopedic surgeon in Fresno, Calif., was charged nearly $4,000 more for a cataract surgery at a hospital outpatient department than his wife who received the same procedure at an ASC, Kaiser Health News reported June 27. In December 2021, 73-year-old Danilo Manimtim, insured by Anthem Blue Cross of California, went to the HOPD of Saint Agnes Medical Center to receive the cataract sur- gery. Overall charges ended up being $9,084 for surgery, anesthesia, medical supplies, pharmacy and clinical labo- ratory services. Anthem paid $5,027 and initially billed Mr. Manimtim $4,057. Four months later, his 66-year-old wife, Marilou Manim- tim, had the same procedure at Fresno-based Eye-Q. Both patients had the same insurance coverage and both providers were in network, but Ms. Marilou ended up ow- ing only $204. "This is ridiculous, and it feels very unfair," Mr. Manimtim told Kaiser Health News. "How can it be so much more expensive than the surgical center? It's walking distance away, and if I would have gone there, I would have saved myself a lot of money." Mr. Manimtim's insurance plan, the California Public Em- ployees' Retirement System, caps payment for outpatient cataract surgery at $2,000. After being contacted by Kaiser Health Network, Anthem reached out to the hospital seek- ing help for Mr. Manimtim. Under Mr. Manimtim's insurance plan, the physician is re- sponsible for requesting an exemption from the $2,000 limit, which didn't happen before the surgery. Anthem then asked the hospital and physician to consider the re- quest after the surgery. Saint Agnes spokesperson Kelley Sanchez told Kaiser Health News that the hospital later requested the exemp- tion and that it was approved by Anthem. The update would leave Mr. Manimtim with a $750 coin- surance bill, with Anthem covering a large portion of the remaining $4,057 bill. n

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