Becker's ASC Review

9 ASC MANAGEMENT ASC owners' biggest concerns for 2024 By Claire Wallace W hile ASC owners are hopeful for growth and expansion in 2024 and more procedures shift to the outpatient setting, there are still roadblocks ahead. In conversations with Becker's, ASC owners and physicians flagged key concerns for the new year, including the loss of physician autonomy, declining reimbursement rates, administrative tasks, burnout and workforce shortages. Many leaders said they are worried that as private practice becomes financially unattainable for many, physicians will lose autonomy and patient outcomes will not be prioritized. "With inflation resulting in rising overhead costs, it becomes more difficult for private practices to remain viable," Marsha Haley, MD, a clinical assistant professor of radiation oncology at the University of Pittsburgh, told Becker's. "These practices are then vulnerable to purchase by large, vertically integrated health systems. Physicians and their patients may then become victims of the corporate practice of medicine, which results in increased physician burnout and a decline in the quality of care.". Other specialists said they are concerned about burnout and its causes as well. "The biggest threat physicians are facing right now is the growing imbalance of increased workload and increased work complexity relative to the compensation and workflow support available to enable provision of the clinical care so desperately needed by our patients and communities," Gregory Smith, MD, an associate professor of medicine at Northwestern Memorial Hospital in Chicago, told Becker's. "I think the administrative burdens of being a physician have become so onerous, where physicians are becoming a scribe of medical records, such that the patient-physician relationship is being progressively destroyed," Cary Passik, MD, chief of cardiothoracic surgery at Good Samaritan Hospital in Suffern, N.Y., said. As the cost of doing business continues to rise in healthcare, reimbursements and payment rates continue to decline, creating challenges for smaller practices such as ASCs. "CMS and insurance reducing reimbursement for patient care and, in turn, hospital administration focusing on patients' length of stay rather than quality care," Min Ho Cho, MD, assistant professor of medicine at UMass Chan Medical School-Baystate in Springfield, Mass., said. Additionally, lots of health problems stem from poor socioeconomic status. So without addressing patients' financial problems, their care will always be incomplete." "The biggest threat facing physicians is the progressive decreases in CMS compensation to physicians for services rendered," Kathleen Yaremchuk, MD, an otolaryngologist at Detroit-based Henry Ford Health, said. "This is causing a decrease in physicians in rural and urban areas, where Medicare and Medicaid is a large percentage of patient insurance. Access is poor and patient access to care decreases as well, which results in issues of healthcare equity." Other specialists said while reimbursement rates do have an impact, worker shortages are the biggest and most overlooked threat headed into 2024. "The single greatest threat is not in bricks and mortar, or implants and supplies or payer reimbursements. Instead, it is systemic national shortages of perioperative professionals, starting with certified registered nurse anesthetists, surgical technologists and registered nurses," Les Jebson, regional administrator at Greenville, S.C.- based Prisma Health, told Becker's. "Those that create a team-based care environment, offer flexible staffing and benefits and tight orchestration of procedure scheduling at specific locations will be better positioned to deal with this threat." n office efficiency has driven many of the training physicians I work with to want to have their own practices. Paramount to the success of those private practices is ASC ownership. ASC ownership has financial gains in itself but also enables a much more productive and happy work experience." 3. Reimbursements ASCs have long faced issues securing reimbursements. And as inflation and costs of living rise, ASCs in many markets are finding that reimbursements are not keeping up, particularly when compared to the reimbursements to hospital outpatient departments. ASCs are oen smaller, freestanding facilities, making it more difficult for them to secure lucrative contracts from payers. Payers are, however, making moves to push procedures to outpatient settings. UnitedHealthcare's 2023 site-of-service policy added codes that require pre-authorization to be performed at an HOPD. e law, which went into effect April 1, will likely push procedures to the ASC setting. "Everything is more expensive. Even though reimbursement has technically gone up, so has the expense side. at puts a lot of strain on the profitability of ASCs," Aric Burke, president and CEO of Atlas Healthcare Partners, told Becker's. "You have to manage costs more effectively than before. You have to have a really strong financial plan that not only focuses on cost control, but also growth. Ultimately, you have to be able to have growth through strong physician recruiting, retention, having service lines and other strategies. Being affiliated with a big health system has been effective in driving growth." n

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