Becker's ASC Review

7 ASC MANAGEMENT 3 California nurse practitioners suing for the title of 'Dr.' By Claire Wallace T hree California nurse practitioners are suing the state for the right to identify using the term "doctor," claiming they have earned the right after receiving their doctorates of nursing practice, according to a Sept. 15 report from the American Medical Association. The DNPs claim that a California statute only allowing California-licensed allopathic and osteopathic physicians to use the term "doctor" is unconstitutional. The restriction has been on the books in the state since 1937. Physicians have testified that the breadth of physician education and practical training eclipses that of nurses' training, and the law avoids confusing patients over who is treating them. Additionally, physicians have noted that patient surveys support the desire to only allow MDs and DOs to identify as "doctors." The Litigation Center of the American Medical Association and State Medical Societies has also urged the state of California to dismiss the lawsuit. n The 3 trends keeping ASC leaders up at night By Patsy Newitt Here are three major trends on which ASC leaders are hyper-focused in 2023: 1. Anesthesia costs Rising anesthesia costs and a declining number of anesthesia providers are strangling ASCs, and many leaders are concerned about how it will affect their ability to provide care. For some, finding anesthesia coverage is difficult, and finding those who understand the workflow of an ASC is an added obstacle. "Anesthesia used to be a seemingly unlimited commodity," Jeff Dottl, principal at Ventura, Calif.-based Physicians Surgery Centers, told Becker's. "ey were lucky to be invited to work at your surgery center. e tables have turned, and now if centers have anyone to cover anesthesia, it usually comes at a hey price." is is compounded by declining reimbursements for anesthesia procedures. "e shi of inpatient to outpatient cases is a given, but this trend may be slowed by the abysmal Medicare reimbursement for anesthesia cases," Andrew Lovewell, CEO at Columbia (Mo.) Orthopaedic Group, told Becker's. "When salaries, wages and benefits are higher for an outpatient total joint than the anesthesia reimbursement, we have a problem. is is a double-edged sword as the case migration needs to happen to save Medicare money on the facility side, but they [Medicare] have to step up the anesthesia reimbursement if this is going to work." 2. Staffing shortages Recruiting and retaining staff are issues that have plagued ASCs for years, and ASC leaders oen cannot compete with the high salaries offered by many hospitals and health systems. Additionally, some leaders are having trouble recruiting staff who fit the needs and work culture of ASCs. "Nursing has always been tough, but it feels more difficult to staff now than in the past," Mr. Dottl said. "Most of the ink goes to rising nursing costs, but another factor of successful registered nurses in ASCs that appears to be diminishing is the independent thinker. So many new graduates want a decision tree for everything." As a solution, some ASC leaders are looking to invest in staff to ensure retention. "Investing in staff and including them in decision-making of the ASC can help improve retention and give the staff agency to explore ways to improve our processes," James Chappuis, MD. founder and CEO at Spine Center Atlanta, told Becker's. "Ultimately, these trends point to utilizing time to bring a deeper human connection back into healthcare." 3. Value-based care While ASCs could be well-positioned to thrive in an industry moving toward value-based care, some leaders worry about the amount of work required in the transition. ASC administrators and physicians must keep a sharp eye on quality outcomes and adapting to new payment structures. "As healthcare reimbursement models shi from fee-for-service to value-based care, ASC leaders must focus on delivering high-quality outcomes and patient satisfaction," Ali Ghalayini, administrator at Munster (Ind.) Surgery Center, told Becker's. But overall, many are hopeful about the opportunities that value- based care has for forward-thinking ASCs. "ASC leaders should actively explore strategies to optimize patient experiences, streamline operational efficiency and demonstrate measurable value to payers and stakeholders," Jitander Dudee, MD, surgeon at Lexington, Ky.-based Medical Vision Institute, told Becker's. "Adapting to these evolving payment structures is crucial for sustaining the long-term success of ASCs." n

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