Reimbursement disparities have caused discord in the ASC sector — even before 2024's CMS cuts.
Here are three executives' thoughts on ASC reimbursement issues:
April Aud, BSN, RN. Administrator of Black River Ambulatory Surgery Center (Poplar Bluff, Mo.): Unfortunately, everything is getting more expensive — supply costs, practice costs, salaries for employees, etc. — but insurance companies don't want to pay anymore, so margins are very, very thin. I worry that eventually, small ASCs in small towns or markets are not going to be able to make it because they can't afford it. Especially because these smaller ASCs often have a lot of Medicare patients, the reimbursement there is not sufficient and there's a limited number of commercial patients. I worry that a lot of small ASCs that serve communities that really need the ASCs in the area are not going to be able to survive. And as bad as it is to talk about the monetary side of it, you have to.
Adeel Faruki, MD. Assistant Professor of Anesthesiology and Perioperative Medicine at MD Anderson Cancer Center (Houston): Declining physician reimbursements with staff shortages are forcing leaders to become creative with their staffing models and reconsider what anesthesia practices will look like in the future. The next few years will see significant changes in the way we practice anesthesia. I am looking forward to seeing how creative ASCs, hospitals and academic institutions become in order to deal with these reimbursement changes in combination with increasing costs of employment.
Steven Waronker, MD. Anesthesiologist affiliated with Emory Healthcare (Alpharetta, Ga.): Since the mid-'80s when I went into private practice, the pendulum has simply swung back and forth with no clear trajectory on how to best handle supply/demand, all in the face of a shrinking reimbursement dollar. Entities like MedPartners and PhyCor were the early equivalent to the current day private equity players. The true challenge is simple to understand and perilous to finally address — and no one wants to face the hard facts to fix. There will be a true physician shortage for years to come, and all physician parent employers must be middlemen. A slice of the pie to the partners or owners by definition must make delivery more cost-effective, or there is less for the physicians.
The conundrum so far has been somewhat mitigated by the ability to increase payments from payers as size and scope via mergers and acquisitions affords this opportunity. Going forward, it will mandate the ability to do more with fewer practicing professionals or finally acquiesce to accept that the salaries for physicians will stay flat or even decrease.
I am mostly an optimist, and for many years of running a large anesthesiology practice when my partners worried or whined about future income, I had two responses: First, none of us will ever worry about job security, and second, I would then send a picture of the physician parking lot, which tended to be flush with pretty vehicles.