Becker's ASC Review

13 ASC MANAGEMENT Hospitals are ending services — here's how 'the ASC industry is reshaping itself' By Riz Hatton While hospitals continue to close service lines, a window of opportunity appears to be opening for ASCs. Leopoldo Rodriguez, MD, chair of the American Society of Anesthesiologists' committee on ambulatory surgical care, connected with Becker's to discuss how ASCs are affected by hospitals closing service lines. Note: This response has been lightly edited for length and clarity. Dr. Leopoldo Rodriguez: Hospitals are closing some service lines due to a lack of staffing, supply chain problems or lack of profitability. So hospitals must concentrate resources on lines of service they have an advantage on, for example, high-level spine surgery, neurosurgery, vascular, cardiovascular surgery, electrophysiologic labs and robotic surgery, which may be too costly for ASCs. Patients still need the procedure performed. This is not a problem; it is an opportunity for growth. The ASC industry is reshaping itself. As private entities, ASCs will choose profitable procedures and engage those service lines. For example, gastroenterology in a hospital is not an efficient service line. The service is offered for GI bleeders, but a hospital can't usually perform at the same velocity and high quality that an ambulatory surgery center can perform elective gastroenterology services because in the ASC there are no emergency cases bumping the schedule, which makes it undesirable for a gastroenterologist. Another great example is urology procedures; hospital operations are less efficient than an ASC performing [extracorporeal shock wave lithotripsy], cystoscopies, ureteroscopy, stenting and even new minimally invasive prostatic procedures. Invasive cardiology procedures are flocking to outpatient cardiac catheterization labs as the CMS inpatient-only list changes. As procedures change facilities, anesthesiologists remain the best-qualified physician to lead and help ASCs select patients and procedures appropriate to ASCs. The goal is to prevent complications, transfer to a higher level of care, improve outcomes using evidence- based medicine, decrease the number of hospital visits after discharge, and increase patient satisfaction by implementing advanced regional anesthesia and continue developing enhanced recovery protocols. n Why some physicians are leaving corporate medicine By Patsy Newitt W hile the physician workforce is increasingly moving to employed models — with more than 108,700 physicians shiing to employment from 2019 to 2021 — some are finding it difficult to maintain autonomy and are making the shi back to private practice. Andrew Gerstner, MD, an independent anesthesiologist and consultant, recently connected with Becker's to discuss how he removed himself from private equity and corporatized medicine. Aer migrating to a smaller, physician-owned hospital from a "giant hospital system," he found he now has a more manageable schedule and is paid more fairly. Most importantly, he added, he no longer has to put up with "being forced to take on more uncompensated or under-compensated work just because the hospital or staffing company has understaffed everything and expect physicians to pick up the slack for their own business mistakes for free." Dr. Gertsner is not the only physician leaving the employed model. Aer growing his practice to one of the biggest multispecialty orthopedic groups in the Hackensack, N.J., area, orthopedic surgeon Michael Gross, MD, sold his practice to a health system in 2021. Aer the sale, however, he found he "wasn't the best corporate person," he told Becker's, and dissolved the deal aer less than a year. "It's really hard to work in your own office where you were the guy running things and now just be another cog in the wheel," he said. However, it is becoming increasingly difficult for physicians to succeed in private practice as operating costs soar. Additionally, private practice requires specialty training in business and government relations that young physicians do not receive in traditional training programs, Harel Deutsch, MD, an associate professor in the department of neurosurgery at Chicago-based Rush University and the co-director of the Rush Spine Center, told Becker's. "Young physicians are not trained in the business aspect of medicine in training," he said. "Some consultants exist that make this process possible, but that also requires capital that a starting physician may not have." But many physicians crave the autonomy, financial opportunities and adaptability private practice can offer. "Practice autonomy and ancillary revenue are the main drivers of the next wave of orthopedic surgeons to pursue a private practice. e 'eat what you kill' model incentivizes increased revenue," Michael Moustoukas, MD, orthopedic surgeon at Sarasota, Fla.-based Kennedy White Orthopedic Center, told Becker's. As the industry becomes increasingly consolidated, physicians who reject employed models will be looking to innovative ways to meet economies of scale. "I will not show any more loyalty to corporatized medicine because their business model relies on taking advantage of physicians and trying to hold them back from their fair market value as highly skilled professionals that went into a ton of debt just to serve society." Dr. Gerstner said. n

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