Becker's Spine Review

23 ASC The fate of private practices By Riz Hatton T he number of private practice physicians in the U.S. is declining, but why? And what does this mean for the future of private practice as a whole? According to a report from the American Medical Association, the number of physicians working in private practices decreased by 13 percent between 2012 and 2022. Many of these physicians are opting to join large health systems, private equity groups or employed settings. e number of physicians younger than 45 who were self- employed decreased by 13 percent between 2012 and 2022, according to the AMA report. "Physicians remaining independent are going to be few and far between. ey're either going to go with these large equity groups or hospitals or something like that," Sheldon Taub, MD, a gastroenterologist at Jupiter (Fla.) Medical Center told Becker's. "You still have a quote, unquote, 'private practice,' but you have guidelines and rules that you have to conform to so it meets their criteria. So right away, you feel a little bit of your autonomy being compromised, and then the bigger the group gets, the more restrictions they have on what you can do to stay in the group and conform to what they want you to do. On top of that, the government throws in their regulations too. e private practitioner is a dying breed." Why are physicians leaving the world of private practice? "With recent reimbursement changes from major medical insurances as well as cuts from CMS, it is very difficult to maintain revenue in private practice," Li Sun, DO, orthopedic and spine surgeon at Sun Orthopaedic & Spine Care in Metuchen, N.J., told Becker's. "I think fewer and fewer private practices will be able to survive on their own without being affiliated with healthcare systems or large [management service organizations]." About 80 percent of physicians who own their practices said the ability to negotiate higher payment rates with insurance companies influenced their decision to sell their practice, according to the AMA report. "Private practice will still be around, just different," Bhagwan Satiani, MD, professor of surgery emeritus in the department of surgery at the Ohio State University in Columbus, told Becker's. "Suspect practices le standing will be: large single-specialty or multispecialty groups or those owned by large national systems such as United Healthcare, Cigna, etc., or private equity. I guess you could call them private. Bottom line, there will be fewer 'self-employed.'" n The future of ASCs in 1 word By Riz Hatton The future of ASCs may prove to be simultaneously bright and challenging. Six ASC leaders connected with Becker's to answer, "What is the future of ASCs in one word and why?" Note: Responses have been lightly edited for length and clarity. Barbara Clancy-Sweeney. Administrator of Thomas Jefferson University Hospital (Philadelphia): Boundless. As advances continue to be made in medicine and technology, more and more procedures become outpatient and are pushed to the ASCs by the payers. Andres Duran. Administrator of Brownsville (Texas) Surgery Center: Growth. Ambulatory surgery centers will continue to grow via acquisitions and de novo facilities. As healthcare transitions to value-based care, ASCs will be vital to that transition, as they perform outpatient procedures at lower rates [compared to] hospitals without affecting patient outcomes or quality. Managed care organizations see the value in that, as do patients. Laura Galeazzi. Administrator of Antelope Valley Surgical Institute (Lancaster, Calif.): Challenging! The rising cost of registered nurses in a very competitive market will continue to drive costs up and potentially cause private centers to evaluate their reasons for why their surgery center should or should not remain open. Additionally, some centers are still struggling with rising costs of anesthesia providers. Providers with varying degrees of experience and expertise continue to increase facility cost and challenge surgery centers. Mary Rose Graham, BSN, MSN. Director of Southtowns Surgery Center (Orchard Park, N.Y.): Growth. ASCs will continue to grow more business as a more cost-effective alternative to the hospitals. Insurances are pushing surgeons to do more cases in the ASC due to lower cost to patients and payers. This will continue in the future. Robert Lerma. Administrator of Coronado Surgery Center (Henderson, Nev.): Agile. Blane Uthman. CEO of Spine Center of Excellence (Bossier City, La.): Ascendant. n "Growth. ASCs will continue to grow more business as a more cost- effective alternative to the hospitals. Insurances are pushing surgeons to do more cases in the ASC due to lower cost to patients and payers." — Mary Rose Graham, BSN, MSN

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