Editor’s note: This interview was edited lightly for clarity and length.
Question: What does the relationship between ASCs and growing hospitals and health systems in Colorado look like?
Simon Schwartz: I think we’re all part of the same healthcare family now. And like any family, there are interesting dynamics — Thanksgiving dinner isn’t always pleasant, but most people can manage a few hours together, right?
I hope we’ve moved past the stage where health systems hold leverage over ASCs just to force partnerships. At this point, we’re all in the same boat. But, like any family, there’s infighting. Sometimes hospital-employed physicians are frustrated with other hospital-employed physicians who also have ownership in a surgery center affiliated with that hospital. That’s an internal battle, and we’re on the periphery of it as an ASC association.
On a state level, I don’t think that dynamic impacts us much. However, when we see legislation like private equity bills coming through that could negatively impact ASCs but not hospitals, we rely on those relationships to help bring our concerns forward.
Q: Are there factors like an aging population or rural-urban disparities that impact ASC operations and patient access in Colorado?
SS: Absolutely. But I think the biggest issues are around scheduling — making sure anesthesiology is available, ensuring doctors can fill their calendars and having the right staff in place.
From a patient volume perspective, I don’t think there’s an issue. The baby boomer generation reached this stage 15 or 20 years ago. The question back then was whether surgery centers were prepared for this wave of patients needing new knees, backs, and shoulders. Now, there are plenty of patients.
What I hear from providers isn’t concern about getting patients in the door — it’s more about making sure patients understand the system. For example, patient satisfaction surveys sometimes reflect frustration with billing issues, which are handled by third-party companies, not the surgery centers themselves.
More broadly, the biggest issue right now is the anesthesiology shortage across the country. Every facility, MSO and hospital partner is trying to figure out how to overcome this challenge in their own way.
Rural facilities may have a harder time than urban ones when it comes to hiring. Some centers might prefer working with third-party anesthesia providers, while others try to handle it internally. There are just so many different ways to approach this issue — it’s difficult to point to one universal solution.
One of the biggest factors I’ve heard from third-party anesthesia providers is that fewer anesthesiologists are graduating. Then there are all the CRNA-related issues, which vary by state. In some states, CRNAs can do almost everything an anesthesiologist can, while in others, they face significant restrictions.
