Becker's ASC Review

8 THOUGHT LEADERSHIP is better outcomes, higher efficiency and lower burnout. e future of ASC operations isn't forcing doctors into a system — it's building a system that reflects the doctor. Michael Verdon, DO. President at Dayton (Ohio) Neurological Associates: ere is an assumption embedded in most discussions of spine care delivery that needs to be challenged: that the system, while strained, is fundamentally intact. It is not. e post- COVID environment has been altered in ways that will not self-correct, and our patients are absorbing the consequences without understanding why. ree forces deserve more honest discussion among those of us running spine practices and programs. e clinical brain drain is permanent, and it starts upstream of us. e mid-to-late career exodus from primary care between 2021 and 2024 was not a staffing event. It was a loss of clinical judgment that no workforce model captures. e internists who retired early were the ones who knew when to escalate, who had the relationships to get a patient in front of us in days rather than months, and who could distinguish mechanical pain from a red flag at the bedside. eir replacements are capable, but the institutional pattern recognition is gone. Patients now arrive at our clinics later, more deconditioned, with incomplete conservative trials and imaging ordered defensively rather than diagnostically. e front end of the referral pipeline is not being rebuilt. Prior authorization has become denial by attrition. e appeals exist, the peer-to-peers exist, the published criteria exist — but the cumulative friction is the product. In spine, the delays compound: weeks for the MRI, weeks for the injection series required before the MRI is deemed necessary, weeks for surgical authorization, weeks for the appeal when the first request is denied on documentation rather than clinical grounds. e natural history of a progressive radiculopathy or cervical myelopathy does not pause for utilization review. Patients feel the symptoms but not the system. ey experience the ten-week wait, the denial letter, the requirement to repeat physical therapy they completed two years ago. ey do not see that the wait exists partly because their PCP retired, or that their MRI was denied for a missing phrase rather than a clinical disagreement. ey blame the front desk, the surgeon, or conclude this is simply how medicine works now. at last conclusion is the most dangerous, because it converts a structural problem into personal resignation. We can keep optimizing on our end — ASC pathways, navigators, in-house authorization teams, direct access models — and we should. ese are necessary and not sufficient. e harder work is naming the system honestly to the people who can change it: patients who can advocate, employers who purchase the plans, and the medical directors who still believe the current friction reflects clinical rigor rather than margin protection. Awareness on our side, without translation to theirs, is just professional grievance. Translation is the work. n What this ASC leader says is driving poor outcomes By Patsy Newitt J oe Peluso, administrator at Aestique Surgery Center in Greensburg, Pa., joined Becker's to discuss how closing the "coordination execution gap" — connecting the right clinical teams, technology, and resources at the point of care — is the key to reducing healthcare costs without sacrificing patient outcomes. Editor's note: this interview was edited lightly for clarity and length. Joe Peluso: Policymakers and healthcare leaders are debating how to address reducing healthcare spending without restricting access to quality care. Healthcare providers need to address the gaps between stated policy treatment goals and actual on-site delivered care focusing on reforms that translate into better and more efficient patient care. Unwarranted variations in the coordination of care TEAMS resources extends to heart attacks, stroke, cancer and other high-risk conditions where diagnostic and treatment delays, and lack of coordinated care add days and even months to rehabilitation, increases the cost of care, and impacts the patient's quality of life. Addressing the variation, consistency and coordination in care delivery TEAMS is the challenge facing providers. The opportunities lie in focusing on pairing needed investments in infrastructure, modern technology and human resources, and the coordination of clinical care TEAMS that ensures care is delivered reliably in real time, addresses payer coverage issues and the need for necessary reforms in care delivery. Providers need to close the "coordination execution gap," by providing clinicians with timely information, connecting the right TEAMS and resources, and providing technological tools to reduce care delays and variation. The consistency of providing high quality care can be achievable by the timely coordination of clinical resource TEAMS directly where patients receive their care. Improving reliability in coordinating point of care resources results in better outcomes, increased available access, and reduced costs. Fragmented care responsibilities among caregivers can lead to inappropriate care variations and excess costs. By standardizing the coordination of care TEAMS with early detection, triage, treatment, and documentation at the point of care, clinicians can rely on rapid coordination and multi specialists' input, resulting in being able to act and intervene earlier, more precisely, avoid costly delays, and duplicative interventions. Many negative procedure outcomes are not the result of bad clinical judgment, technique or intentions but are the result of fragmented processes and lack of care coordination where both unwarranted outcomes and inefficiencies prevail. Strengthening the reliability of care coordination at point of care as part of aligned clinical TEAMS decision making addresses the gap between what clinical evidence recommends and what patients consistently receive Together policymakers and health system leaders must focus on improving the coordination of care at the moment it's delivered by TEAMS. n

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