Becker's connected with Denise Mills, MSN, RN, director of perianesthesia services at Virginia Mason Franciscan Health in Tacoma, Wash., to discuss the industry developments that have proved the most challenging for ASCs.
Editor's note: Responses have been lightly edited for length and clarity.
Question: What are the biggest issues affecting ASCs right now?
Denise Mills: The biggest challenge for us right now would be making sure that we can provide that work-life balance that people want. On our end, we need to provide the number of cases to make that work, and ensure that we are being properly reimbursed — because CMS keeps changing the reimbursement model — so those clinicians see that reimbursement.
It's really hard for ASCs to stay standing. Much of the time, we are an external entity helping ourselves, and if our reimbursements keep going down, then we won't be able to survive in this environment.
As a leader, you have to be able to wade through all that minutia, and you have to be able to balance staff needs and successful business practice.
The other thing has to do with the acuity of the patients. Since Obamacare, the acuity of the patients has tripled. Now, we have patients who never went to the doctor because they never had the ability to go to the doctor, so now, they come in with seven things wrong that they were never able to get treatment for.
Then, you have to play catch-up. They want to get their trigger finger fixed, but they have diabetes, they only have one lung, they have major heart disease. Then you're like, wait a minute, this one trigger finger is now going to cost who knows how much, but CMS says it should be a day procedure. When in reality, for a person who's sick, it could be a week or month in the hospital.
We've had to become very creative about the acuity of patients, by making sure that the nurses understand and buy into that, so they're willing to take care of those patients while factoring in the lack of resources compared to larger hospitals.
Much of the time, ASCs are losing patient populations because they're not fitting into that healthy, ideal patient mold anymore. Patients are having to go to hospitals because they're not as healthy as they used to be and have more comorbidities.