Becker's ASC Review

7 ASC MANAGEMENT What an ASC did to avoid room shutdowns By Laura Dyrda A ndrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, realized his surgery center had a problem. e demand for services was high, but cases couldn't get scheduled because of gaps in anesthesia coverage. "We were going to maybe potentially shut down rooms or we had to shut down rooms intermittently," said Mr. Lovewell on the "Becker's Ambulatory Surgery Centers" podcast. "at hurts the bottom line because if you can't do surgery, you can't figure out how to pay all the costs associated with running a big ASC like ours." e surgery center had to rethink its anesthesia model to survive. And it's not alone. "One of the biggest things is if you're in the ASC world and you're doing cases, you can't turn your attention away from the anesthesia crisis we're facing," said Mr. Lovewell. "We did a pivot here internally where we've actually taken the stance of employing our own anesthesia group that used to provide services for us." Columbia Orthopedics, which has around 30 musculoskeletal physicians and owns a large surgery center, brought on the anesthesiologists as employees with fully aligned incentives for future growth and expansion. Mr. Lovewell increased the benefit package and compensation level for the anesthesiologists upon employment to stay competitive in the market and make sure the surgery center had top talent. "It's very imperative for us to be able to turn cases over quickly and find people who want to work in that atmosphere," said Mr. Lovewell. "e anesthesia crisis across our country is one thing that everyone in our ASC space is facing and we have to keep that top of mind." Employing anesthesiologists could make sense for the anesthesia group as well, especially if the surgery center has a better benefits package. "If they're a smaller group, they can't get the same rates with health insurance or dental or vision, but let us employ them, let us figure out what the comp model needs to look like, the vacation, the CME to everything that's necessary," said Mr. Lovwell. e lead physician of the anesthesiology practice worked with Mr. Lovewell and his team to align on the mission and model for ASC employment. e group started the transition Jan. 1, and has made adjustments since then. Mr. Lovewell said it has been a "mindset shi" to bring on anesthesia as a different business line. "It's hard to find talent in that area, especially that want to work at the level that's demanded in an ASC because our expectation for turnover times or case turnaround, or all those things, is quite different than the hospitals," said Mr. Lovewell. His surgery center has a turnaround time of 10 minutes or less for most cases, as compared to a 30 minute target for many cases at the hospital. "What we're discovering and finding in the anesthesia space is if we incentivize production and productivity and throughput, make sure our staff are well taken care of, and compensated and well respected, we're creating a winning environment that way," said Mr. Lovewell. n UnitedHealth's physician group ownership targeted in antitrust investigation By Laura Dyrda U nitedHealth Group is the target of a Justice Department antitrust investigation, according to The Wall Street Journal. Investigators are zeroing in on the company's ownership across sectors, including physician groups, pharmacy drug benefits and a major health plan. UnitedHealth Group has two major divisions: UnitedHealthcare, its health plan, and Optum, which includes its pharmacy and physician services groups. Optum owns primary care and specialty physician groups, as well as SCA Health, a network of more than 320 ASCs and surgical facilities. As of last November, Optum had 90,000 physicians including 9,200 affiliated with SCA Health, making it one of the largest physician networks in the country. Optum also includes Change Healthcare, a claims processing platform used by more than 70,000 providers. Change was hit by a cyberattack Feb. 21, and the IT system recovery is ongoing. The DOJ is questioning UnitedHealth about the relationship between Optum and UnitedHealthcare, and the effect physician group acquisitions have on local communities. Optum's physician groups serve patients covered by UnitedHealthcare plans as well as competing health plans. However, investigators are examining whether UnitedHealthcare favors Optum-owned physician practices, which could hurt competing practices. Investigators are also taking a look at Optum-owned medical groups' billing practices to determine compliance with federal rules capping the amount health insurance companies can retain from premiums collected, according to the Journal. The cap is 15% to 20% of premiums retained for administrative costs and profits, but the combined company "may absorb far more than the capped amount," according to the report. This isn't the first time UnitedHealth has been questioned about antitrust issues. The federal government challenged Optum's combination with Change Healthcare two years ago, but the transaction was eventually approved. n

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