Leaders across the ASC landscape are identifying both long-standing and emerging burdens that are quietly eroding profitability.
Here are five of the most pressing financial burdens ASCs face today”
1. Inefficient OR time and scheduling practices
One of the most commonly overlooked financial drains for ASCs is inefficient use of operating room time, according to Heather Combs, RN, ASC Administrator at Austin (Texas) Regional Clinic. Whether the issue stems from underutilization, poor scheduling, idle time or long turnover periods, these inefficiencies can significantly undercut profits.
“Administrators focus on monthly case volume, case costing, staffing matrix and supply cost, all very important metrics, but often overlooked when the ORs are not operating at capacity,” she told Becker’s.
Even when ORs sit unused, ASCs continue to incur fixed costs for equipment, staffing and infrastructure. To improve efficiency, some ASCs are leveraging analytics and proactive scheduling. For instance, Pradnya Mitroo, MD, of Fresno (Calif.) Digestive Health, shared a model that increases block fill rates by offering unused vacation-time slots to other providers in advance.
2. Persistent reimbursement disparities
The widening gap between ASC and hospital outpatient department reimbursement rates is another major financial stressor, said Kathleen Hickman, BSN, RN, administrator and clinical director of Dutchess Ambulatory Surgical Center in Poughkeepsie, N.Y.
“Costs continue to soar for supplies, pharmaceuticals, etc., with only incremental increases (or none) in reimbursements for ASCs,” she said. “Negotiating payer contracts as an independent ASCs presents significant challenges in terms of substantiating the need for higher reimbursement simply to stay ahead of operational costs.”
According to a 2023 analysis by Blue Health Intelligence, the Blue Cross Blue Shield Association’s data analytics company, procedures done in HOPDs can cost 58% more than a physician’s office or ASC. Facility fees for colonoscopy procedures covered by private health insurance are 55% more at hospitals compared with those at ASCs as of May 2023, according to a study published in JAMA Health Forum.
3. Employee turnover
Turnover and burnout among healthcare staff are significant but often underestimated cost burdens. Healthcare staffing costs are climbing across the board, straining ASC budgets. In 2023, 43% of ASCs reported operating budgets of $3 million or more, up from 32% in 2022, according to a survey from OR Manager. A substantial portion of that increase is tied to escalating labor expenses.
“The cost of recruiting, hiring and training a new employee makes a significant impact on productivity and efficiency,” Andrew Weiss, administrator of Vorhees, N.J.-based Summit Surgical Center, said. “Treat your employees fairly and with respect; the payoff is incalculable.”
Benjamin Stein, MD, president and CEO of Capital Orthopaedic Surgery Center in Germantown, Md., noted that burnout-related turnover often forces ASCs to use costly staffing agencies and results in reduced efficiency due to less familiar personnel, further impacting throughput and escalating indirect costs.
4. Anesthesia-related budget strains
Anesthesia services are becoming a growing budget concern amid a projected shortage of 6,300 anesthesiologists by 2026, according to a 2024 white paper from Medicus Healthcare Solutions.
Traditionally, anesthesia groups billed separately, but changes in availability and compensation expectations are pushing ASCs to subsidize these services.
“Now, ASCs often need to guarantee hours and offset collections due to changes in anesthesia availability,” Stephanie Tomlin, RN, administrator of Tucson, Ariz.-based Rincon Surgery Center, said. “This shift requires ASCs to adjust their budget structures, making it essential to incorporate these costs into financial projections from the start.”
5. Rising supply issues
Supply back orders and product allocations are an increasingly disruptive financial burden, according to Melissa Waibel, BSN, CEO of Guam Surgicenter. The time and labor required to locate alternative products, often more expensive, add to payroll and procurement costs.
“The time and effort to secure products currently is increasing, and I believe it will continue to do so for the next two years,” she said. “That means more payroll hours and higher prices and potentially higher shipping prices for similar products.”
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