Although the ASC industry is largely fragmented, independence is becoming increasingly difficult as practice costs soar and healthcare consolidates.
During a June 22 panel at the 21st Annual Spine, Orthopedic & Pain Management-Driven ASC + The Future of Spine Conference in Chicago, leaders joined Becker's to discuss the the threats and obstacles facing independent ASCs
"You should stay independent until the selling price is right or the purchase price is correct," Dr. Sev Hrywnak, MD, a podiatrist in Chicago, said during the panel discussion.
Here are five factors affecting the future of independent ASCs, from leaders at the panel:
1. Sticking with outdated staffing strategies.
Recruiting and retaining staff is a huge issue for ASCs as they often can't compete with hospital salaries.
Jene' Becerra, director of nursing at Crown Point Surgical Suites, said that her teams' biggest issue is staffing.
"It's hard to find staff that have been trained in surgery," she said. "They don't really talk about that in nursing schools, so circulators especially are very hard to find. That's why we're sharing staff with other centers… It's hard to find those circulators or techs that are experienced already, and for them coming into an ASC, it is better to have that experience because we want to stay efficient and we don't want to have to take a couple months or three months to train someone into that role."
2. Allowing surgeons to have idle block time.
Because independent ASCs are operating on a smaller scale, it's critical for centers to remain efficient in order to maintain profitability.
"Certainly block time utilization [is necessary for cost containment], or to try to make sure you have a spine day or a pain day or elements that people are more proficient to handle," Curtis Mayse, CEO of Steamboat Springs, Colo.-based Steamboat Orthopaedic and Spine Institute, said during the panel. "You don't want idle time relative to those aspects, and you certainly want folks that are flexible that can move between roles to some extent to be able to make that sense, but it's challenging to make that happen."
3. Selecting the wrong implant vendor and allowing reps to upsell in the OR.
ASCs are also facing skyrocketing implant costs, meaning contracting with the right vendors and securing lucrative contracts is critical.
"On the implant side we're seeing double digit increased costs," Mr. Mayes said. "We're certainly getting the surgeon to choose the right implant or vendor and trying to consolidate that, but the costs are significantly going much higher and quicker than any reimbursement or payer are keeping up."
4. Performing unprofitable cases where costs exceed reimbursement.
Procedures are increasingly moving to the ASC setting, but leaders have to think critically about efficient and cost-effective ways to add these service lines.
"We're trying to bring as much volume as we could relative to that, but on the spine side, it's very interesting relative to which of those cases were bought," Mr. Mays said. "As we looked at three level fusions or three level disc replacements, we had to understand the separate pricing because reimbursement didn't always match that … There's elements to make sure we understand the margin, not just bringing cases but other things that actually pay us a profit margin there."
Ms. Becerra echoed these thoughts, saying "the hardest thing sometimes is to choose those cases that should be done at a hospital versus the outpatient surgery center," so sometimes leaders have to steer surgeons to the most cost-effective procedures rather than the highest acuity.
"Sometimes the surgeons want to bring those cases to an ASC, because it may be easier, but it may not be cost-effective for the surgery center," she said. "So that is one thing that you really have to watch."
5. Not challenging prior authorization denials.
Prior authorizations are another major obstacle for independent ASCs to secure reimbursements.
Nearly 97% of providers have had delays or denials for necessary patient care due to prior authorization requirements, according to the Medical Group Management Association's 2023 "Regulatory Burden Report." Additionally, prior authorization denials for outpatient care claims jumped 16% in the last three years.
"We fight all the time with medical necessity, with the reviews, with the prior authorization," Dr. Hrywnak said. "The paperwork is just insurmountable at times and you have to have a good staff to fight it because it is a burnout, especially on the billing side."