Some ASC leaders say the Western market, particularly California, is primed for ASC growth after that state's COVID-19 regulations required hospitals and ASCs in the area to coordinate equipment, staffing and patient needs in the area, highlighting the benefits of care within ASCs.
Four ASC leaders spoke with Becker's ASC Review about the Western ASC market and what may or may not make it unique.
Editor's note: Becker's followed U.S. Census regions for this piece. This piece was edited lightly for brevity and clarity.
Question: How does the ASC industry in the West differ from other markets in the country?
Beth LaBouyer, RN. Executive Director of the California Ambulatory Surgery Association: The response to the COVID-19 pandemic was different, particularly in California, with rapidly changing rules that impacted healthcare providers and patient access to care. The state created a pathway for regional responses based on the unique impact of the pandemic at different times in different geographies. This made it a necessity for ASCs and hospital systems to maintain real-time coordination on the availability of equipment, staffing and patient needs in their area. ASCs filled a very important role in allowing patients to continue to get access to surgical care and have elective procedures done even when hospitals were overloaded and the backlog of care was increasing. In this way, COVID-19 accelerated the adoption and awareness of ASCs as an important part of the patient care system, and those lessons will have long-term benefits that fuel the continued growth trajectory for the ASC industry.
We will continue to see more cases, as well as more complex cases, migrate to the ASC setting due to its clear value proposition. In particular, there is continued growth in orthopedics, gastroenterology and cardiovascular cases. As an industry, we have to be prepared to meet this growing demand, which means building out the surgery center teams, refining processes and prioritizing quality training to ensure case migration is done the right way.
Brian Gantwerker, MD. Neurosurgeon and Head of Craniospinal Center of Los Angeles: For one, the majority of the ASCs were started by physicians. Most of the ASCs in the Los Angeles market began with physicians' seed money, with angel investors. A number of them were acquired or bought out by larger hospital systems and are now joint ventures. They, for the most part, are fairly well-run, but the days of big buyout money are long gone. While we all expected the majority of spine to be transitioned to outpatient, the pullback of the inpatient-only codes now slingshotting back out of outpatient and returning to inpatient has cooled the outpatient spine market. That being said, there is still room for growth in outpatient spine surgery, as long as it's done responsibly and safely.
Sharon Benson. Past President of Arizona Ambulatory Surgery Center Association and COO of American Vision Partners: The Western market is dealing with the same issues that are impacting the rest of the country. Specifically, declining payer reimbursements, rising inflation costs that are impacting our employees who are mainly living paycheck to paycheck, the lingering impact of COVID-19 and the "Great Resignation’s" impact on staffing, as we see more people leaving the medical profession. There is no magic formula for success in the Western market. Success in any market is predicated on cultural fit, scheduling flexibility and overall employee benefits.
Q: What are some of the biggest threats to ASCs in your market?
Oren Shill. President Elect of California Ambulatory Surgery Association's board of directors and Group President of Surgical Care Affiliates: Shortages of healthcare providers and the ASC workforce is the biggest threat right now. The pandemic created significant staffing challenges for nurses and office staff, and we are also seeing an accelerated trend of practice consolidation, an aging healthcare workforce and changes in how physician specialists are focusing their practice. Physician specialists are looking to enhance sustainability of their practices and see a series of benefits from participating in an integrated care delivery system and values-based care models. That means that ASCs must work hard to build awareness of their benefits, attract physician specialists and nurture the connections to value-oriented primary care doctors and payers to reinforce siting of patient cases at ASCs. We are also making investments in talent acquisition, leadership programs and training for clinical and support teams to attract and retain top talent with compelling career growth opportunities.
Dr. Gantwerker: By and large the biggest threat is the infiltration of hospital culture into the ASC. In other words, when efficiency and safety are traded for the asymptotic slowing of case turnover and random delays in processing and tray delivery, not to mention the ever-elusive and disappearing anesthesiologist and/or random checkbox paperwork delays, ASCs become less able to do what they do best.
Panna Tailor, RN. Employee Health Nurse Manager at three Northern California ASCs: The biggest threat is patient's trust in the system. They are the ones who will spread the word of a particular surgery center. Physician-owned surgery centers also recruit different specialists or particular specialists depending on the multispecialities or few specialities surgeries.
Q: What does it take for ASCs to be successful in the Western market?
Ms. LaBouyer: In order to be successful, ASCs need to look ahead. Healthcare is constantly changing and evolving. Patient needs are also evolving. ASCs across the region are expanding current service lines and adding new capabilities. Due to advances in pain management and surgical technology, total joint replacements and spine surgery continue to be a huge area of growth and opportunity. By 2029, total joint outpatient volumes will outpace inpatient volume. So ASCs need to prepare for this by implementing total joint programs, dedicating operations teams and clinicians who specialize in this, and working with vendors, facility partners and physician groups to be ready to transition more of these cases into the ASC setting. Additionally, physician specialists need to nurture their connections to value-oriented primary care providers and payers as a way to care for more patients
Dr. Gantwerker: In the Western market, ASCs can capitalize on patient demand. By providing an outstanding patient experience, good nursing care and excellent surgeons, patients will opt for a cleaner, better-run outpatient environment for their care. Perhaps the out-of-network model, then, is not dead after all. Rushing to sign up with all the insurers and racing to the very bottom price-point wise — one or all of these will suffer. It is possible — some competent and savvy group can cut out the insurers altogether and market themselves directly to the patients. But contracting and competing for the lowest price to the point of implosion is not a viable business model.