Becker's ASC Review

19 THOUGHT LEADERSHIP 'Historically' slow payers hindering ASC procedure migration, admin says By Patsy Newitt W hile many procedures are migrating to the ASC setting, "historically" slow payer policy changes could create delays, according to administrator Brenda Carter. Ms. Carter, administrator of Wilmington (N.C.) Surgcare, joined Becker's to discuss what procedures she sees moving to the ASC setting, along with potential barriers. Editor's note: This response was edited lightly for brevity and clarity. Question: What procedures are moving to the ASC setting? Brenda Carter: The future looks bright for more total joint cases in the ASC, along with spine and cardiology. The push to the ASC creates a better patient experience, reduces costs and can ease the burden on overwhelmed, understaffed hospital facilities. However, insurance carriers will need to revisit the procedures previously only allowed in the hospital setting to create an easy transition to ASCs. As the carriers have historically been slow to respond to changing trends, this may initially present some challenges. n John Woodward Jr., MD, Orthopedic Surgeon at Orthopaedic Physicians of Colorado (Englewood): Keep the volume up as the flu season is on the way. Keep the staff working a full schedule. Work a little harder to make up for lost productivity over the last year. Improve the supply chain issues that have continued to plague health care. Mark Mattar, MD. Director of MedStar Georgetown University Hospital's IBD Center (Washington, D.C.): My secret to success stems from the framework of transformational servant leadership. Leading in a successful GI practice in a health system as we come out of a pandemic brings its own special challenges. At the end of the day, we focus on the people. We prioritize patient care without compromising associate wellness. We work as a team to evaluate each of the provider's needs and how we can help them work toward our common mission. is isn't easy, but when you pay attention to the needs of the team and act on them, we all succeed. Chris Blackburn, BSN. Administrator of South Kansas City SurgiCenter (Overland Park): Increase volume by retaining staff and recruiting surgeons Mark Mineo. Director of the Millard Fillmore Surgery Center (Williamsville, N.Y.): My top priority is to get fully staffed throughout the ASC so we can start the new year with volume growth and continue to recruit new surgeons. Omar Khokhar, MD. Gastroenterologist in Bloomington, Ill.: Facilitating access to colonoscopy screening remains a priority. Colorectal cancer screening rates nationwide are still short of our goal of 80 percent. Getting to that number requires a team effort: patient education and awareness, prompt primary care physician referrals, seamless scheduling and a great patient experience throughout the process. Medicine is undergoing a "Starbucks" moment — we need to improve our experience. n Prior authorization: 3 leaders' thoughts By Patsy Newitt S eventy-nine percent of medical groups said that payer prior authorization requirements increased in the last year, according to a March poll conducted by the Medical Group Management Association. Here are three leaders' thoughts on prior authorization: Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): e biggest issue with Medicare is the ever-increasing regulatory and documentation burden. It is getting more difficult and requires more practice resources to stay compliant with all of their regulations, most of which do not actually benefit patient care. For example, the recent development of requiring prior authorization for cervical fusion surgery made it much more difficult to get those operations done in a timely manner. Kenneth Nwosu, MD. Spine surgeon at NeoSpine (Burien and Puyallup, Wash.): My biggest industry concern is the ever increasing barriers by payers to provide high value care to our most vulnerable patients in a timely fashion. Over time, it appears that the default decision for procedures needing prior authorization is a denial, as indicated by a rising number of peer-to-peer reviews where the reviewing physician openly states that the ordered surgery should not have been denied. Alternatively, I am seeing more denials where a peer-to-peer review time is dictated by the payer, which is oen in conflict with the treating physician's availability. In some instances, there is not an option to partake in a peer-to-peer review following a denial. Nick Jain, MD. DISC Sports & Spine Center (Newport Beach, Calif.): While prior authorization for [anterior cervical discectomy and fusion] is an obvious target due to the increased authorization process burden and delay in care, I think the decreasing CMS fee will prove to be the most detrimental recent change to patient care. As reimbursement costs decrease while staffing costs and inflation soar to all-time highs, physicians will be forced to spend less time with patients to make ends meet, resulting in shorter face-to-face visits with an increasingly sicker and older patient population who require our full attention and dedication. is will only lead to the further degradation of the physician-patient relationship and, for that reason, I would eliminate the recent cuts to the CMS fee schedule. n

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