Becker's ASC Review

10 THOUGHT LEADERSHIP The biggest lessons ASCs learned in 2023 By Patsy Newitt Seven ASC leaders recently joined Becker's to discuss the biggest lessons they learned in 2023. Editor's note: ese responses were edited lightly for brevity and clarity. DJ Hill. CEO of Compass Surgical Partners (Raleigh, N.C.): Trend one of 2023 was the continued resiliency of the ASC market as consumers, CMS and health systems continue to see the value ASCs bring to all stakeholders across the market. Overall, opportunities continue to expand. Trend two of 2023 is the continued acceptance of health systems that ASCs must be part of their strategy going forward. We've seen most systems across the country reassess their ASC plans, footprint and partners in a search for real partnership, solutions and a strategy. Grant Cook. CEO of National Surgery Consultants: It is becoming increasingly difficult to add smaller market payer contracts. Panels are closed and payers are pushing back on adding additional providers, including ASCs. Ira Richterman, MD. Orthopedic Surgeon at OrthoUnited Spectrum (Canton, Ohio): e biggest lesson ASCs learned in 2023 is to recognize they can maintain and hire staff at a lower pay rate than hospitals as long as the ASC provides the life-work balance the staff desires. Working during the day — and no nights, weekends or holidays — certainly represents a great value. Hospital systems have created an unsustainable pay scale escalation. ese overinflated labor costs are having detrimental consequences to their financial survival. Secondary to the Medicare failure to recognize the fact that paying physicians at 1994 Medicare reimbursement rates is absolutely depleting the physician pool and ultimately is creating a massive physician shortage. John Critser. CFO of Eye Associates of Tucson (Ariz.): We learned that independent anesthesia coverage cannot be assumed and taken for granted. A significant shortage of providers developed during 2023 and led to a few instances of canceled surgery days due to lack of anesthesia coverage. We had to quickly rally and come up with creative solutions simply to stay open. Julie Baker, RN. Administrator of Andover (Mass.) Surgery Center: I would say the biggest thing the ASC industry has learned is to be adaptable. Any operating room in any facility is always unknown, but adding a COVID-19 spike and unforeseen cancellations means you have to constantly change how you approach things. What worked a year ago might not work today, and what works today will most likely have to be reworked in the future to meet new guidelines, less staff and maintain a budget. Larry Bauss, MD. Medical Director of Surgery Center of Kalamazoo (Mich.): e biggest lesson we have learned in 2023 is flexibility. For so many years now, we have been able to make a given number of operating rooms available to our surgeons with the hope that the case volumes they provide us would hit our efficiency targets. Now, with the anesthesiologist and CRNA shortages, we have suddenly found ourselves reversing the paradigm: "If you give me a full day of cases, I'll give you an operating room with anesthesia coverage." is has been a difficult adjustment for our surgeons. Many have found it necessary to do cases on traditional office days or days they would ordinarily do hospital cases. Also, waiting for a full day of cases can cause longer wait times for patients. Unfortunately, we really don't see this changing in the foreseeable future. Shawna Alfano, MSN, RN. Administrator and Director of Nursing of BASS Surgery Center (Walnut Creek, Calif.): In terms of the biggest lessons learned this year, I would say that has to land with having an anesthesia backup plan, when there could be immediate shortages of coverage combined with learning the critical role CRNAs may be playing in the future of ASCs. Without anesthesia, it really does not matter whether a center can run successfully, from a financial standpoint, as you are not running anything without the proper medical staff to perform the cases. n Why this physician is worried about Medicare Advantage By Patsy Newitt A growing number of hospitals, health systems and ASCs are dropping Medicare Advantage contracts for prior authorization denials and slow payments, among other reasons. Patrick McEneaney, DPM, owner and CEO of Crystal Lake-based Northern Illinois Foot & Ankle Specialists, joined Becker's to discuss why he is worried about Medicare Advantage in 2024. Editor's note: This response was edited lightly for clarity and length. Dr. Patrick McEneaney: The healthcare trend that I'm most worried about in 2024 is the increasing number of patients who are signing up for Medicare Advantage Plans. I have found that my most vulnerable patients are picking up these plans. These are patients who have multiple comorbidities, are at high risk for exacerbations of their medical conditions and/or those who have insecurities with their socioeconomic situations. These plans are touted by brokers promising extended benefits and significant cost savings. However, the savings are often only on the front end of the program at the time they sign up. Many patients don't realize that these plans may have copays, coinsurance and deductibles, which often cost the patients more in the long run. I see patients skipping visits, treatments or diagnostic testing in fear of the costs associated with these plans, which leads to poorer outcomes. The aggressive advertisements and monetization of these patients' lives to brokers' commissions have led to a significant amount of misunderstanding from patients. n

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