From reimbursement declines to increased competition from hospitals and other players, six ASC leaders joined Becker's to discuss what's threatening the future of ASCs.
Question: What scares you for the future of ASCs? Why?
Editor's note: These responses were edited lightly for clarity and length.
Shakeel Ahmed, MD. CEO of Atlas Surgical Group (St. Louis): There is the growing pressure from regulatory changes and political pressure from opposing forces. Plus, with rising cost of doing business, and the anathema of bundled payments for surgeries, it's getting harder and harder to stay afloat. Add to that the reimbursement challenges. As healthcare policies evolve, there is uncertainty around Medicare and private payer reimbursement rates, which unfortunately always favor the larger hospital systems and reduce the financial viability of ASCs.
Additionally, I have noticed an ever-increasing accreditation and administrative burden, and it continues to divert our focus from what really matters: patient care. COVID-19 has led to increased cost in medical supplies and staffing, all of which puts a squeeze on our profit margins. We routinely make decisions to discontinue a line of service simply because they become financially unsustainable. Unless CMS adjusts its reimbursement policies drastically, I suspect quite a few specialty surgeries will continue to stay inside the walls of expensive and financially unmanageable hospital networks.
Bruce Feldman. Administrator of Eastern Orange Ambulatory Surgery Center (Cornwall, N.Y.): As the acuity level of procedures in the ASC setting continues to grow, so does the cost associated with doing these procedures. Reimbursement from third-party insurance payers has not followed suit. The growing shortage of anesthesiologists and the financial and operational impact it is having on ASCs is also of great concern.
Michael Foldes. Sales Consultant for MFI Electronics/Medical (Endwell, N.Y.): Competition is fierce as more and more hospital systems are branching out with their own remote facilities that offer ambulatory services. Some areas will become oversaturated with specialty facilities that are privately run; hospitals will see lower volumes and face declining revenues; finding competent personnel and qualified providers could become more difficult as facilities compete for top talent.
Leslie Jebson. Administrator, The Orthopedics and Sports Medicine Network at Prisma Health (Greenville, S.C.): I’m not sure "scared" is the right term, but I share the same concerns as my colleagues throughout the country — having enough skilled ASC team members in sterile processing, surgical technology and nursing to be able to continue to keep pace with the overall ASC market growth.
Jennifer Robinson, RN. Director of the Center for Special Surgery (Norfolk, Va.): Continued CMS cuts and increasing red tape mandates make me nervous for ASCs. These are not 24-hour operations, but at the end of the day, we still have staff to pay and lights to keep on. In a workforce that continues to dwindle and the need to be able to pay staff competitively with hospital salaries for quality care, reimbursement cuts are really hurting our industry.
Joe Peluso. Administrator at Aestique Surgical Center (Greensburg, Pa.): ASCs are facing a number of financial challenges with Medicare and commercial payment plans not keeping up with the rising costs of doing business. Overall rising costs are expected to grow approximately 8% by 2025 due to ongoing inflationary pressures, as well as evolving regulatory demands. ASCs are being forced to do more with less. The delay in payers moving to fair and equitable "site neutral" payments, and CMS slow to transition more procedures that can be safely performed in ASCs.
Mitchell Schwarzbach. Healthcare Consultant and Former ASC Director (Bellevue, Colo.): Having smaller (one to three ORs) multi-specialty ASCs continuing to do any and all types of cases. Due to lower volume, they lack the ability for staff and providers to get really good at doing the same cases over and over again, leading to a higher percent of bad or not-great patient outcomes.