While several challenges that physicians and health systems faced during the heart of the COVID-19 pandemic in 2020 have improved over the last five years, healthcare leaders fear they may be worsening again.
Here are five key challenges ASCs faced during the COVID-19 pandemic that remain a struggle for many systems:
Supply chain challenges
Tariffs could bump the price of hospital supplies and CFOs in particular are zeroing in on the exact cost of each component of critical supplies. Specifically, they are paying renewed attention to where those supplies are sourced to project possible effects over the next several years.
“The billion-dollar question, quite literally, is how do we plan around all of this in order to maintain long term stability and to keep reinvesting to deliver on our promise of delivering high quality clinical care, creating the next generation healthcare workforce, and continuously pushing the boundaries of science and innovation?” Greg Damron, CFO of University of Missouri Health Care in Columbia, told Becker’s recently. “There are so many scenarios that have to be considered and planned against that it would not be hard to get paralyzed and be reactive to change versus being able to chart a steady course through the turbulence.”
Economists have warned that President Donald Trump’s tariffs will raise costs for consumers, especially in states that rely on imports from China, Canada and Mexico. The administration’s decision to impose a 25% tariff is expected to affect the medical industry, especially device companies that rely on steel and aluminum imports.
“Microeconomics shows that before a tariff is in place, consumer consumption increases due to the lower cost of goods. Our corporation has been purchasing additional electronics and furniture (consumer surplus) in anticipation of future tariffs,” Robert Tatsumi, MD, president of Oregon Spine Care in Tualatin, told Becker’s. “Tariffs create inefficiencies in the market and lead to higher supply costs regardless of where the product is manufactured (deadweight loss). We anticipate reduced consumer spending to adjust for reduced business profits. Our supply chain pressure has remained neutral for the current fiscal year due to flexibility with sourcing various suppliers.”
“Over the past years, our supply chains have generally improved in line with our recovery globally from the pandemic. In our experience, this has not yet returned to baseline, and certain specific and notable distinctions persist,” Peter Passias, MD, orthopedic spine surgeon at NYU Langone Health in New York City, told Becker’s. “There have also been individual hurdles related to random natural disasters, such as the recent shortage in IV fluids with recent extreme weather. In preparation for the tariffs, this has been considered, along with general inflationary related pressures, and projections for diminished reimbursements in certain scenarios. This is generally reflected in our drive for streamlining cost efficiency and OR efficiency to maximize volume. There will certainly be an anticipation of selective utilization of more cost-effective alternatives in several cases.”
Staffing issues
Burnout and staff turnover are becoming quiet but costly threats to ASCs.
Staff retention and turnover is becoming a “silent” force undermining ASCs’ financial performance, Benjamin Stein, MD, president and CEO of Capital Orthopaedic Surgery Center (Germantown, Md.), told Becker’s.
“As an administrator, the most difficult challenge is balancing the clinical staffing needs of the facility and managing personnel costs while ensuring adequate hours are provided to retain your core staff,” Christopher Merhan, administrator of Memorial Hermann Surgery Center Woodforest in Montgomery, Texas, told Becker’s. “Case volumes in the ambulatory surgery setting are prone to ebb and flow. Some days may be extremely busy, and cases may go well into the evening, while other days may have one or two cases scheduled. Therefore, influenced by demand, staffing must remain fluid and teammates must accept the implications of working in an ASC setting.”
“Although we employ enough staff, we are encountering unexpected time off issues as it relates to surgery, care of elders, sick children, and as associates get older, they are requesting less workdays,” Lori Sylvester, administrator of Riverside Outpatient Surgery Center in Columbus, Ohio, said.
Drug shortages
Drug shortages persist nationwide, across all specialties. Weekly, more and more drugs are added to the drug supply shortage databases from the FDA and the American Society of Health-System Pharmacists.
Drug shortages continue to be a widespread issue, with more than 99% of hospital and health system pharmacists reporting shortages, according to the American Hospital Association, with 85% describing the impact as critical or moderate.
The AHA is raising alarms over the potential fallout from a series of recently implemented tariffs, warning it could negatively impact patient care and worsen existing drug shortages.
AHA Chair Tina Decker warned that tariffs on critical items like pharmaceuticals, medical devices and personal protective equipment could exacerbate drug shortages, drive up costs and disrupt care.
Citing past supply chain challenges such as the IV fluid shortage after Hurricane Helene, she emphasized the urgency around exempting essential medical imports from the tariffs.
“Tariffs on these items could impact patient care by jeopardizing the availability of vital medications and essential health care devices,” Ms. Decker said. “They also could raise costs for hospitals and heighten shortages and supply chain disruptions.”
General industry uncertainty
Craig Albanese, MD, CEO of Duke University Health System in Durham, N.C., identified uncertainty as a unique challenge for today’s leaders. He recognized that heading into this year, many health systems continued to lose money and confront service cuts, workforce reductions and more.
“Amid unprecedented volatility, resource constraints and technical disruption, how can healthcare executives rapidly adapt and transform their organizations to sustainably deliver high-value care, optimize operational efficiency and preserve workforce resilience and empathy?” he told Becker’s, as his billion-dollar question.
Gina Hawley, DrPH, COO of University of Utah Health and Clinics in Salt Lake City, said healthcare leaders needed to balance extreme challenges coming from state and federal regulators, technology advancement, financial and capacity issues and more during “times of unprecedented changes.”
“At University of Utah Hospitals and Clinics and U Health, we’re continuing various efforts through our financial, operational and capacity plans, while also keeping a close, data-driven eye on external shifts and possible impacts to our patients, teams and communities,” she said.
Micahel Antoniades, president of UChicago Medicine Ingalls Memorial, had a similar outlook for leadership through heading into the second half of the year.
“Executives must deploy strategic foresight, operational efficiency, robust recruitment initiatives and innovative retention strategies to safeguard financial health and ensure sustainable care delivery in this precarious landscape. And yet, many hospitals will not be able to weather the storms,” he said.
Burnout
While burnout among physicians fell overall last year, several specialties still reported rates above 50%, according to findings released July 9, 2024, from the American Medical Association’s national physician comparison report.
In 2023, 48.2% of physicians reported experiencing one or more symptoms of burnout, down from 53% the year prior.
During the COVID-19 pandemic, physician burnout and job dissatisfaction rates reached historic highs. In the years since, burnout rates have come down — though not nearly enough to ease concerns about the nation’s physician shortage and patient access to high-quality care.
Every three years since 2011, researchers at Stanford (Calif.) Medicine have surveyed practicing physicians to track changes in burnout and well-being among the workforce. The latest edition, published April 9 in Mayo Clinic Proceedings, is based on responses from more than 7,600 physicians surveyed between late 2023 and early 2024.
Overall, 45.2% of physicians reported experiencing at least one symptom of burnout in 2023. This is down from 62.8% from an off-cycle version of the survey conducted at the height of the pandemic in 2021. Still, experts say burnout rates in medicine are stubbornly high. As part of their analysis, researchers also compared physician burnout rates to a sample of non-physician workers from the general population.
After adjusting for age, gender, hours worked per week and other factors, they found that physicians were 82.3% more likely to experience burnout than employees in other jobs.
“While the improvement in physician burnout is encouraging, levels remain substantially higher than the rest of the U.S. workforce,” Tait Shanafelt, MD, lead study author and chief wellness officer at Stanford Medicine, told Becker’s. “Given the evidence that physician burnout impacts patient experience, quality, reductions in clinical work effort, turnover and the cost of care delivered, the high rates of occupational burnout continue to have a substantial detrimental impact on organizational effectiveness and the ability of organizations to respond to the other challenges they are facing.”
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