ASCs want higher reimbursements now: 5 leaders' thoughts 

For many ASCs, cost pressures persist and payers haven't adjusted to reflect rising costs. 

Here are five ASC leaders on reimbursement pressures:

Aric Burke. President and CEO of Atlas Healthcare Partners: Everything is more expensive. Even though reimbursement has technically gone up, so has the expense side. That puts a lot of strain on the profitability of ASCs. You have to manage costs more effectively than before. You have to have a really strong financial plan that not only focuses on cost control, but also growth. Ultimately, you have to be able to have growth through strong physician recruiting, retention, having service lines and other strategies. Being affiliated with a big health system has been effective in driving growth.

George Dickstein, MD. Gastroenterologist at Boston Endoscopy Center: The anesthesia staffing shortages are not easily solved, particularly as reimbursement shrinks in many markets. Many ASCs are swallowing the bitter pill that they now have to supplement anesthesia pay with stipends or guaranteed day rates to keep sufficient staff. Discord between scope of practice among CRNAs and MDs does not help the matter. However, there are major staff shortages even in states where the working relationship between MDs and CRNAs is very good.

Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: The trend toward increasing bureaucratic maze walking and decreasing reimbursements and remuneration from the largest payers, including Medicare, and the shunting of more patients into what are HMOs, should concern all physicians. The rise of managed care in the 1980s and now incredibly byzantine private insurance systems seem to be pressuring doctors to leave medicine prematurely, close their practices and become employed, and to in some cases leave for other countries. Both Congress and the Department of Health and Human Services should be concerned for patient access to qualified physicians. Lowered fees are being justified by the bureaucracy because they state doctors' fees are driving up costs. Paradoxically, physicians reimbursement has been going down for the last 20 years, and in the case of neurosurgery by almost 25 percent.  

Olga Medowska. Director of Operations at ANR Clinic (Tampa, Fla.): We all know that the entire healthcare industry is facing strong headwinds. The reimbursements for hospitals and ASCs continue to decrease despite expenses increasing exponentially. At the same time, ASCs are unique environments allowing them to capitalize on several opportunities. One strategy ASCs can use to their advantage is strategic partnerships. Whether with hospitals or physicians, alliances and joint ventures can help drive volume and increase revenues. Investing in technology and automation is another opportunity to increase productivity and cost-effectiveness. We are on the brink of AI being a part of everyday life. The key is to use this emerging technology to optimize operations, reduce staff workload and improve employee satisfaction and patient experience.

Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): Unfortunately, physicians are losing money in multiple scenarios in medicine. The most prominent loss of physician revenue is Medicare's consistent decreasing of physician reimbursement in office settings while supporting hospital-setting healthcare services. This trend affects all insurances, as Medicare is the benchmark of most if not all healthcare insurance reimbursement. 

The overall decrease of physician revenue from employment models is based on the commoditization of healthcare professionals as systems are trying to minimize costs while providing acceptable care. This squeeze is occurring across many healthcare settings, from standalone urgent care/emergency departments to hospital settings. The value of physicians is still strong among the community and patients; however, care models, for better or worse, are removing physicians' involvement in triage/entry exposure to healthcare, leading to less opportunities. 

Outside of traditional healthcare systems, physicians may be undervalued as consultants at times. There are many healthcare startups looking for clinical acumen through side gigs or consulting that offer physicians positions at rates that are fractions of their clinical training worth, especially if the physician does not have a background in business, healthcare management or IT. 

Another opportunity lost came with legislation preventing physicians to take part of ownership in hospitals with the concern of healthcare overutilization, but this stance may be reversed. While there may be scenarios of physicians losing money, nearly 47 percent of physicians are older than 55 and will soon face retirement. This will cause an immediate demand for physician services that should drive value up, and salaries along with it.

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