2024 has been a year of seismic shifts and bold perspectives in the ASC industry, with leaders grappling with the accelerating consolidation of physician practices, reimbursement challenges and the ongoing shift toward ASCs.
From warnings about the dangers of oligopolies to calls for prioritizing patient care over profits, here are five thought-provoking perspectives shared with Becker's.
"We sold our souls and have nothing"
As the migration to employment accelerates, many physicians are finding themselves unhappy with the effects of consolidation on autonomy and care quality.
Here's one leader's thoughts on the downfall of this trend:
Matt Mazurek, MD. Assistant Professor of Anesthesiology at Yale School of Medicine (New Haven, Conn.): Nearly 78% of physicians now are employed, and that percentage keeps creeping up. I think consolidation has not really produced the results that were promised by the consolidation. First of all, access has not improved. It's gotten worse. Second of all, costs have not reduced — it's actually increased across the board. I don't see consolidation producing all of the promises that were made when it was pitched with some health systems having approached the leaders in a particular community promising access to various resources. It really hasn't come to fruition. Same thing with the physician groups. They promised physicians if they joined they would have resources and funding, but I don't see that that's actually come to fruition either.
I think there has been a lot of hope and a lot of good ideas that at the end of the day, the money is being siphoned off for some communities into other areas without any return on the promises made. So everyone's kind of staring at themselves wondering what happened. We sold our souls and have nothing. It's a huge issue.
"Profit needs to take a back seat where health and lives are involved"
Following massive backlash, Anthem Blue Cross Blue Shield reversed its decision on a controversial anesthesia reimbursement policy update that would have introduced a new reimbursement structure based on CMS physician work time values.
Here's one leader's thoughts on continued anesthesia reimbursement cuts:
Udaya Padakandla, MD. President of the Texas Society of Anesthesiologists: I can't read the insurers' minds, but I do sincerely hope this decision to rescind such a capricious policy gets the insurers to really rethink their policies on making profits for their shareholders at any and every expense. They have been systematically chopping down payments to physicians, and unjustly denying services to patients by implementing draconian pre-authorization requirements (another greedy attempt at maximizing profits). They do need to take a step back and see for themselves how far they have taken the profit motive in healthcare markets. The healthcare market is NOT the goose that lays the golden egg.
This also brings up a thought in my mind. I always wondered why only physicians are beholden to the Hippocratic oath. In fact such an oath, "to NOT harm the patient (and the physician that takes care of the patient)" should be instituted for every entity that steps into the arena of healthcare — be it a facility, ASC/hospital, nursing home, PBM, GPO or an insurance carrier. After all, health — and healthcare by extension — have been turned into commodities on Wall Street, to the detriment of our own population. Profit needs to take a back seat where health and lives are involved. That is a better way forward for civilized societies.
"I have seen over and over the effect of oligopoly in the ASC industry"
Earlier this year, Optum, parent company of ASC chain SCA Health, set its sights on acquiring Brentwood, Tenn.-based ASC operator Surgery Partners, sparking apprehension among ASC leaders.
Here's one leader's concerns with the potential deal:
Shakeel Ahmed, MD. CEO of Atlas Surgical Group in St. Louis: When two large companies merge, that naturally creates a buzz. What makes me apprehensive is how this will create another step towards monopolization of our industry. Consolidation stifles competition. It creates higher pricing and limits choices for consumers… I have seen over and over the effect of oligopoly in the ASC industry. A dominant group takes over the local market and edges out smaller businesses. That is not a healthy model, and I remain nervous about that with these future mergers. We need a level playing field. The ASC industry stands as a bulwark of fairness against large healthcare institutions. These mergers go against the dogma that we stand for.
"Death by a thousand cuts"
CMS finalized a 2.83% physician pay cut for 25, sparking outrage amongst physicians who have seen continued pay cuts that aren't keeping up with the rising cost of practice.
Here's one leader's thoughts:
Thomas Loftus, MD, Neurosurgeon at the Austin (Texas) Neurosurgical Institute: There will be, and already has been for so many, a breaking point in which it no longer makes sense to practice medicine. We will all become simple hospital or private equity employees with little autonomy. It is very possible that this is simply the way our government plans to take over healthcare without actually saying it out loud. Death by a thousand cuts."
"The ASC shift is real"
In May, medtech company Zimmer Biomet announced a partnership with commercial real estate services and investment firm CBRE Group to create and outfit ASCs and one of it's executives joined Becker's to discuss the company's continued shift towards ASCs.
Nnamdi Njoku. Zimmer Biomet's President of Sports Medicine, Surgery, Upper Extremities and Restorative Therapies: As a company, we know that this is going to be a big part of our future. We are embedding that understanding and that desire to win in the ASC space into all aspects of our business — not only how we think about the products we design, but also how we go to market, as well as how we become a better partner for surgeons and other providers we work with. We're thinking very creatively about how to be part of the solution to meet the needs of ASC stakeholders in the healthcare marketplace."