From revenue cycle to supply costs, five ASC leaders joined Becker’s to discuss the current threats to ASC success.
Editor’s note: These responses have been edited lightly for clarity and length.
Question: What currently poses the greatest threat to ASC success?
Trina Cole, BSN, RN. Administrator of St. Luke’s Surgicenter Lee’s Summit (Mo.): I would say this is an ongoing threat, but revenue cycle comes to my mind. The increased number of peer-to-peer reviews, pre-authorization being received and then retracted is leading to an increase in denials that are not coming to light until procedures have been completed.
Greg DeConciliis. Administrator at Boston Out-Patient Surgical Suites: The continued rising cost of medical supplies and implants. The price of these items has not recovered since the COVID-19 spike, and the costs of these items continue to hurt profitability. In addition, escalating staffing costs continue to be an issue. There are not enough qualified staff with outpatient experience, and in order to obtain specialized staff you have to win in salary and benefits. The two of these line items together consume much, if not all, of our profitability. When you couple this with minimal, if any, increases from the insurers — it’s costing us more to do business, and we are making less or at best the same. If we are defining success as volatility and the ability to survive, we continue to see the headwinds of physician employment by hospitals, not only on the specialist (surgeon) side, but also on the referral side. Controlling where patients have their surgery hurts our only revenue generator — surgical patients.
Richard Evans, MD. Vice President of Surgical Services and Director Mini Medical College at Bon Secours Charity Health System (Suffern, N.Y.): The greatest threat to ASC success depends on if the ASC is owned and operated by a hospital system or independently owned by practitioners. If an ASC is owned by private practitioners, the status of the ASC is predicated on if the practitioners remain independent or join a hospital system. The trend over the past decade has been for hospital systems to employ surgeons. In this scenario, the surgeons are often obligated to resign their ownership stake in their independently owned ASC and move their cases to the hospital employing them. The decreased volume weakens the financial stability of the ASC until enough of the stake holders resign and leave the independent ASC with insufficient volume to survive. A hospital system-owned ASC has the optimum opportunity for growth and expansion. The hospital system employed physicians must perform their cases in the hospital ASC — contingent only upon the medical status of the patient being conducive to outpatient treatment.
Tracy Helmer, BSN, RN. Administrator of Tri-City Surgical Centers (Mesa, Ariz.): Lobbying efforts from larger groups that seek to disrupt the forward progress of the patient-centric focus of ASCs has been the largest threat to success. As a whole, the ASC market is still small, compared to the other markets that have a large interest in maintaining control of the locations that patients choose for their healthcare, and that is not always the most economical option. ASCs provide both a high-quality and an affordable option for patients and payers, but we don’t always have the chance to perform certain comparable surgeries in our centers.
Rebecca Anne Vitillo, BSN, RN. Administrator at Meadows Surgery Center (Nutley, N.J.): There are a few possible issues that could affect the ASCs in the future. One being staffing constraints and another being the rising costs of supplies and equipment for daily operations. There is concern that certain equipment that we use in our facilities would need parts, etc., from areas that have economic sanctions placed on them, therefore making the equipment difficult to procure or fiscally prohibitive.
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