From procedure migration to growing provider and supply shortages, key ASC leaders are keeping an eye on several trends in the industry, some hopeful and some concerning.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at its 29th annual conference, the Business and Operations of ASCs, on October 26-28 in Chicago. The following are answers from our speakers.
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If you would like to join as a speaker, contact Claire Wallace at firstname.lastname@example.org.
Question: What are the top two trends you are watching as an ASC leader right now?
Adam Bruggeman, MD. Orthopedic Surgeon at Texas Spine Care Center (San Antonio): I am most closely watching how the reimbursement and the covered procedures list for ASCs modifies over time. These two issues are the biggest barriers to outpatient migration of cases. Reimbursement in many device-intensive procedures is insufficient to allow for the procedure to be done at an ASC.
Ahmed Elsahy, MD. Anesthesiologist at IU Health University Hospital Interventional & Advanced Pain Therapies (Indianapolis): As an ASC leader, there are several trends that we are closely monitoring due to their potential impact on the industry. Here are the top two:
1. Shift to outpatient surgery: One of the most significant trends we are watching is the continued shift from inpatient to outpatient surgeries. With advancements in technology and surgical techniques, more complex procedures are being safely and efficiently performed in ASCs. This trend is expected to continue as it often provides a more cost-effective and convenient option for patients. However, it also requires ASCs to continually update their facilities and skills to handle more complex cases.
2. Adoption of value-based care: The healthcare industry as a whole is moving toward value-based care, and ASCs are no exception. This model focuses on patient outcomes and cost-effectiveness, rather than the traditional fee-for-service model. ASCs are increasingly participating in bundled payment programs and other value-based initiatives. This trend necessitates a focus on quality improvement, data collection and analysis to demonstrate value and achieve positive patient outcomes. Both of these trends present both challenges and opportunities for ASCs, and staying abreast of these changes is crucial for strategic planning and decision-making.
Alejandro Badia, MD. Hand and Upper Limb Surgeon at Badia Hand to Shoulder Center (Doral, Fla.): 1. I am excited to see the higher acuity cases finally coming to ASCs for surgery given the disruption that the pandemic inspired. We have now seen that total joint replacements, complex spine surgery and many cardiovascular cases can be safely done in the independent ASC environment. This naturally impacts cost, but we are seeing increased efficiency and even better results due to this focused approach that is much better for our overall healthcare system.
2. Surgery centers are beginning to seek patient-centered approaches to increasing surgical case volume. Recruiting surgeons has been the mainstay of ASC success, but it is now apparent that the public prefers this alternative to the traditional hospital, and any strategy that increases consumer engagement is being considered. This can be direct consumer marketing, affiliated orthopedic walk-in centers, or athletic team affiliations.
Ali Ghalayini. Administrator at Munster (Ind.) Surgery Center: For administrators in the ASC world, staying abreast of trends is not just important, it's crucial for the success and sustainability of their centers. Following trends allows us to make informed decisions, adapt strategies and position our ASCs effectively in a dynamic and evolving healthcare landscape. Here are the top three trends I watch:
1. Technology integration and automation: ASCs have increasingly adopted technology to improve efficiency, patient experience and overall operations. This trend includes implementing electronic health records and practice management software to streamline patient scheduling, billing and medical records management. Telehealth and virtual consultations have also gained traction, allowing ASCs to provide preoperative assessments, postoperative follow-ups and consultations remotely. Furthermore, supply chain management, inventory control and equipment maintenance automation can lead to cost savings and better resource utilization.
2. Value-based care and quality metrics: As healthcare reimbursement models shift from fee-for-service to value-based care, ASC leaders must focus on delivering high-quality outcomes and patient satisfaction. Centers that can demonstrate efficient and effective care delivery while maintaining excellent patient experiences will likely be rewarded. Therefore, tracking and improving key performance indicators such as infection rates, patient-reported outcomes, readmission rates and patient satisfaction scores are essential. Collaborations with payers and accountable care organizations to align incentives and performance goals can be advantageous.
3. Expansion of services and specialties: Many ASCs have been diversifying the range of services they offer beyond traditional surgical procedures. This includes expanding into new specialties such as cardiology, orthopedics, gastroenterology, pain management and more. By adding a broader array of procedures, ASCs can increase patient volume and revenue streams. However, entering new specialties requires careful planning, credentialing and compliance with regulatory requirements. Collaboration with specialists and physicians from various fields is crucial to ensure successful expansion.
Remember that the healthcare sector is constantly in flux, and trends can shift swiftly. As leaders within an ASC, it becomes paramount to remain current with the most recent industry developments. This involves staying attuned to the latest news, actively participating in pertinent conferences, fostering connections within professional circles and consistently evaluating how these trends intersect with our unique center. By doing so, we equip ourselves to make well-informed choices and flexibly adjust our strategies to navigate the evolving terrain adeptly.
Ali Mesiwala, MD. Neurosurgeon at DISC Sports & Spine Center (Newport Beach, Calif.): As we look to continually expand our services, contracts that offer enhanced payments based on quality metrics and contracts that permit the full spectrum of spine care are more important than ever. Hospitals are increasingly focused on inpatient work, while surgeons are looking for facilities that are purpose built for specialized care and efficiencies. In order to recruit more cases from surgeons and reward them for delivering cutting-edge care, while taking on these challenges, there needs to be appropriate incentives in place to reward them for this work. By doing so, we can continue to improve patient care and outcomes while reducing the overall cost of care.
Alyson Hughes, MSN, RN. Director of Nursing at Andrews Institute Surgery Center (Gulf Breeze, Fla.): 1. Anterior cervical discectomy and fusion in an ASC.
2. Tricare reimbursement at ASCs.
3. Robotics and total joint arthroplasty.
4. Bundled payment options.
Andrew Lovewell. CEO at Columbia (Mo.) Orthopaedic Group: One of the top trends that I am watching is the critical labor shortage that exists in the healthcare space today. Particularly, anesthesia is a massive issue that all of us are affected by. The shift of inpatient to outpatient cases is a given, but this trend may be slowed by the abysmal Medicare reimbursement for anesthesia cases. When salaries, wages and benefits are higher for an outpatient total joint than the anesthesia reimbursement we have a problem. This is a double-edged sword as the case migration needs to happen to save Medicare money on the facility side but they (Medicare) has to step up the anesthesia reimbursement if this is going to work. The second trend that I am following is the decline in mergers and acquisitions in the private equity space. KPMG recently released a report that Q2 of 2023 experienced the lowest activity in the last three years. Many private practice groups are catching on to the "second bite" and are learning from peer experience. Private groups are wrestling with several issues right now, but the ones with successful ASCs should not look to a PE deal. There are still ways to win and become the ASC/provider of choice. Value-based arrangements, workers compensation, direct-to-employer, etc. are all great opportunities to feed the practices that are still solo. There's no doubt that strength in numbers still exists, but I predict that many private practice groups will lean on collaboration with each other to develop size and economies of scale.
Andy Paulson. Executive Director at Central Illinois Endoscopy Center (Peoria): The two trends we are watching are the increase in costs (labor and supply) as compared to the increase in reimbursements. We are also watching the availability of providers in our specialty, gastroenterology.
Bruce Feldman. Associate Administrator of SUNY Downstate Medical Center (New York City): The top two trends I am seeing as an ASC leader is more complex procedures moving out of the hospital and into the ASC arena. This is most notable with orthopedic, spine cases and cardiovascular procedures. The second trend is greater difficulty in recruiting seasoned ASC clinical staff and retaining them.
Chris Shaver, MD. Gastroenterologist at Birmingham (Ala.) Gastroenterology Associates: 1. Continuing our efforts to relocate all appropriate outpatient procedures from hospitals' GI labs to our freestanding ASCs. This includes some endoscopic ultrasounds. The process involves updating protocols for our schedulers as well as tweaking our relationships with hospitals, who covet our hospital-based procedures.
2. Partnering with hospital systems to create new, cost-efficient ASCs that enable us to expand our practice footprint in the state.
3. Continuing to stay ahead of barriers to gold standard, routine screening colonoscopies including alternative screening modalities and colonoscopy pre-authorizations.
Crystal Marcum. Chief Operating Officer of Pain Care (Stockbridge, Ga.): 1. Medicare payment guidelines on sedation allowed with pain management procedures.
2. Techniques and trends on hiring new talent and motivating staff.
David Jevsevar, MD. CEO at OrthoVirginia (Blacksburg): 1. Value-based contracting for ASC services is increasing. This has been especially true in the arthroplasty world but is now moving to all orthopedic subspecialties. This trend is providing great opportunities for those ASCs that can manage them.
2. Cost containment. While always important, implant/device cost management is more important than ever. Margins continue to erode as the cost for employees and supplies escalate. Supply chain is at the forefront.
Deena Edwards, BSN, RN. Administrator of the Surgery Center of Southwest Ohio (Moraine): The top two trends I am watching right now are salary rates and case costing. When it comes to salary rates, we are especially looking at anesthesia costs and pay scales for nurses and scrub technicians. Knowing how to recruit for these positions/contracts without breaking the budget can be challenging. We are also watching case costing and reviewing all processes in our surgery center to try and be the most efficient we can, because efficiency saves money.
Emily Spooner. CEO of South Florida Same Day Surgery Center (Pompano Beach): As an ASC leader in the current economy, I am watching the cost of supplies and materials continue to rise. In an attempt to circumvent the decreasing profit margins as the cost of supply rises, we need to be always on the lookout for better pricing and create competition between vendors.
The second trend that we are seeing is the influence of new technology in the ASC industry to improve struggling workflows due to staffing shortages. There are many new products on the market, and the ASC industry is finally trending toward technology instead of away from it.
Emma Gimmel, BSN, RN. Director of Nursing at Manhattan Endoscopy (New York City): 1. From a global perspective, reimbursement changes involving our services and our providers may have an effect in our budgets, requiring us to look for opportunities to make adjustments. The old adage "do more with less" seems to be a constant change on the table and to do list. I find myself with an ear attentive to proposed or changes made to reimbursements that could affect us.
2. As a single-specialty, GI/endoscopy/gastroenterology diagnostic ASC, the supply chain and market have changed from "pre-COVID" to note, prices and allocations. We know that shortages, recalls, or anything that interrupts availability of our supply inventory can affect us almost on the spot. I find myself watching for news and updates related to GI/endoscopy supplies to ensure we can anticipate needs and possible alternatives in order to prevent any interruption of services. This can be in procedure-related supplies as much as medications or patient care supplies.
3. If I may add one more, the most expensive commodity can quickly become prohibiting. I find myself attentive to trends in employment, staffing, "flavor of the month" in regards to what people are looking for, staying with or the novelty of the "great resignation" evolving into other modalities such as "silent resignation" and such. By observing these trends, one can do some anticipating, calculating, planning and identify the opportunities and strategies to avoid staff challenges or even crisis.
Evalyn Cole. Administrator at Pacific Cardiovascular Center (Salem, Ore.): Since Pacific Cardiovascular Center is the first cardiology ASC in Oregon, our primary challenge is finding experienced employees. This is a challenging priority for all ASCs. As outpatient services expand and become more prolific, performing procedures that have been the bread and butter of hospitals, they must compete for a shrinking qualified employee pool, which expects increasing salaries, benefits and other perks. All of this, even though ASC payments fail to keep pace with HOPD's reimbursement increases and ASCs are further burdened with gross revenue taxes, yet many hospitals are "nonprofit" and pay little, if any taxes at all.
James Chappuis, MD. Orthopedic Spine Surgeon and Founder and CEO at Spine Center Atlanta: The top two trends I am watching right now in ASCs are integration of AI and investing in staff. New technologies are a critical part of progress and evolution of improving efficiency in healthcare. With AI, we have been able to utilize necessary but monotonous tasks to increase time we can spend focused on patient care and streamline communication between us, caregivers and patients. Investing in staff and including them in decision-making of the ASC can help improve retention and give the staff agency to explore ways to improve our processes. Ultimately, these trends point to utilizing time to bring a deeper human connection back into healthcare.
Jason Goodwin, RN. Associate Professor of Nursing at Sacramento (Calif.) City College and Surveyor at AAAHC: 1. The shrinkage of operating margins: The shortage of staff, rise in salary requirements, change in the market for non-traditional nursing roles, continued non-parity of reimbursement versus acute care and supply chain challenges continue to strain the ASC smaller businesses. These businesses have to pay the same expenses for labor and goods as the hospitals, but make less profit in many instances.
2. Shortages in the nursing and staffing market: We are seeing more and more difficulty in finding and keeping good clinical staff. We are seeing candidates that want higher salaries and more flexibility, and we are seeing a flat out inability to find travelers/registry in the event of last minute needs. This has never happened in my career to this level, and it is compressing our ability to provide surgical access.
Jayesh Dayal, MD. Anesthesiologist at White Flint Surgery (Rockville, Md.): This trend is not that obvious as yet, but the ACO/value-based model is incentivizing primary care provider groups to restrict testing, delay surgery or treat non-surgically most common surgeries — and the perception that any testing, or surgery, is going to directly diminish the pot of savings promised to the group, is gaining traction in PCP circles. It is mostly designed to keep surgery out of hospitals, but that message is being lost in PCP circles and they are getting paranoid about sending out any testing and surgery, period. This trend will have very serious consequences on the profitability of ASCs that need a certain volume of surgeries to break even and be viable.
Jeff Dottl. Principal at Physicians Surgery Centers (Ventura, Calif.): The top two trends I am seeing shouldn't come as a surprise: anesthesia and staffing (nursing specifically). Anesthesia used to be a seemingly unlimited commodity. They were lucky to be invited to work at your surgery center. The tables have turned, and now if centers have anyone to cover anesthesia, it usually comes at a hefty price. Nursing has always been tough but feels more difficult to staff now than in the past. Most of the ink goes to rising nursing costs, but another factor of successful registered nurses in ASCs that appears to be diminishing is the independent thinker. So many new graduates want a decision tree for everything. The best RNs (especially in an ASC) are those that can think on their feet and fill multiple roles in the (usually small) organization.
Jeffrey Flynn. Vice President of the New York State Association of Ambulatory Surgery Centers and Senior Vice President at the Gramercy Group (New York City): The trend I am watching now:
1. Anesthesia coverage shortage is hitting the Northeast very hard right now. New anesthesia models are emerging that the ASCs need to be conscious of for the bottom line.
2. The second trend I am watching closely is the clinical staff shortages and new ways to stave off its effect on ASCs.
Jitander Dudee, MD. Surgeon at Medical Vision Institute (Lexington, Ky.): Two significant current trends that have the potential to shape the industry's future are:
1. Advancements in minimally invasive techniques and technology. The ASC landscape is witnessing a continuous evolution in minimally invasive surgical techniques and technology. This trend not only enhances patient outcomes by reducing complications and recovery times but also aligns with the growing demand for outpatient procedures. ASC leaders should stay informed about the latest developments in robotics, laparoscopy and other innovative tools that can improve surgical precision and patient satisfaction.
2. Value-based care and reimbursement models. The shift toward value-based care and alternative reimbursement models is gaining momentum within the healthcare sector. ASCs are well-positioned to excel in this environment due to their ability to deliver high-quality, cost-effective care. ASC leaders should actively explore strategies to optimize patient experiences, streamline operational efficiency and demonstrate measurable value to payers and stakeholders. Adapting to these evolving payment structures is crucial for sustaining the long-term success of ASCs. By closely monitoring and responding to these trends, ASCs can remain at the forefront of innovation and consistently deliver exceptional care to patients while navigating the changing healthcare landscape.
Johnny Russell. Director of Area Operations at Sutter Health (Sacramento, Calif.): We are focused on the severe anesthesia shortage and how it impacts our volume daily.
John Prunskis, MD. CEO and Medical Director of the Illinois Pain & Spine Institute (Elgin): The two trends I'm watching now are:
1. The growing momentum to have payment equity between hospital outpatient payments and ASC payments. This would assist in saving Medicare.
2. The unfortunate observation of hospital employed physicians being told to schedule procedures in the hospital outpatient setting to increase hospital profits instead of taking them to more cost-effective ASC settings. This is contributing to the financial difficulties of Medicare.
Julie Berzins, BSN, RN. Vice President of ASC Operations at American Pain Consortium Management (Carmel, Ind.): Some trends that I am seeing are regarding staffing. We are seeing more sign-on bonuses being offered that are tied to one- or two-year commitments. Since there does seem to be a shortage of specialty nurses (like operating room RNs) more centers are utilizing travelers and instate recruitment companies. All types of creative staffing models are popping up, including partnering with schools to attempt to pick the best apple off the tree. While trying to capture as many candidates as possible, there is a trend in using digital assistance or artificial intelligence to steer candidates to your inbox. Virtual or Zoom face-to-face interviews help make the first impressions count with a candidate. This also saves the recruitment team time and money by eliminating some unproductive in-person interviews. A center's virtual online presence is paramount. Routinely, this is the first place a candidate will look to research your center. Facilities that have a strong social media presence are attracting the fast thinking, fast moving digital generation.
Kenneth Candido, MD. CEO and President of Chicago Anesthesia Associates: 1. Increasingly complex cases (spine fusions, joint replacements) being conducted in ASCs leading to potential for increased risk and complications and possibility of admission to hospitals.
2. Difficulty securing anesthesia coverage regularly due to lack of skilled providers who are demanding higher day rates for services and whose availability has become increasingly competitive.
Khawar Siddique, MD. Neurosurgeon and Co-CEO of DOCS Health (Los Angeles): 1. Bundling payment contracts in the ASC setting.
2. Clinical and financial parameters that determine which spine/orthopedic cases should be done in hospital versus ASC settings.
Larry Trenk. Vice President of Operations at Physicians Endoscopy (Jamison, Pa.): 1. Affiliating with health care systems/hospitals.
2. Blending ASC's and practices to achieve synergies and insure succession planning.
Mark Chaplick, DO. Pain Management Specialist at Midwest Pain Management Center (Lee's Summit, Mo.): Reimbursement rates by managed care for the ASC. The other item is delays in authorization by managed care for routine procedures that in the past were very timely authorizations or none were required.
Mark Mayo. Founder and Owner of Mark Mayo Healthcare Consultants (Chicago): Post COVID-19 pandemic, I am seeing renewed interest in developing new surgery centers. ASCs "proved" that during the crisis, they could continue surgical services in a safe way. Patients learned more about the ASC option to hospital-based elective surgery and felt more comfortable going to an ASC rather than to the hospital. This movement to create new surgery centers or expand existing center capacity may also be due to pent-up demand for procedures that were postponed during the pandemic. Many ASCs are rededicating themselves to staff development and staff appreciation after facing staffing shortages over the past three years. Our employees are critical to our success in providing patient-centered service and in delivery of high quality care. Centers forced to temporarily close during the pandemic have been rebuilding their team. Leaders are much more focused on retention of valued employees. Teams are promoting among themselves a cohesive work group of colleagues, thereby reducing extraneous stress factors. This all leads, we hope, to lower staff turnover and dissatisfaction. Happy staff, happy doctors and happy patients!
Matthew Gee. CEO at Alabama Orthopedic Clinic (Mobile): Two major trends that we are watching in the ASC space right now are the consistent shifting of historically hospital-dominated caseloads and the partnerships that drive and allow the shift to occur. As we move forward and into the future, we continue to see a trend of increasing caseload that includes more complicated and difficult surgical interventions within the ASC setting. With an aging population, shifting payer mixes and challenges associated with anesthesia services nationwide, the historical dominance of the inpatient setting continues to dwindle. As more and more patients access care in ASC settings, CMS and other payers within our space will continue to incentivize a shift into a setting that focuses on high quality, low cost care. In addition, as that shift continues to occur, the relationships between the ASCs and vendors commonly associated with medical devices and other associated product lines will become more and more important. Rather than seeing this as a simple "race to the bottom," this trend will begin to unfold as a "race to greater overall value." Rather than focusing on common sales techniques and negotiated financial structures, the relationship between the facility and the vendor will begin to morph into a relationship that works somewhat backwards as compared to historical norms, ultimately triggering greater accommodation for bi-directional success.
Melissa Loteria. Executive Director at Seven Oaks Surgery Center (San Bernardino, Calif.): 1. Payer trends to see if they are more open to traditional HOPD/IP procedures to be done at an ASC setting.
2. Bundled surgical packages for patients.
Michael Powers. Administrator of Children's West Surgery Center (Knoxville, Tenn.):
1. Looking at creative ways to utilize staff in cross training (we have a shortage of certified surgical technologists and programs moving to an associate degree will have a negative influence on the already shortage) and what is happening in our region to continue to be competitive in maintaining the right staffing mix and metrics.
2. How to continue to grow profitability while juggling increasing staffing, medical supplies and pharmaceutical costs while focusing on contract negotiations for continued revenue growth to offset these increasing costs. In addition, frequently looking at overhead costs such as scrubs, linen, biomedical, etc. and shop around to ensure we continue to balance great service for the best price.
Njideka Nto, MD. Medical Director and Family Medicine Consultant at Mediclinic Middle East (Dubai): One of the trends which holds my interest is intelligent automation of RCM process and the value this brings. Automated revenue cycle management processes decrease the length of days required to get our payment from both patients and insurers and also decreases staff overheads costs as repetitive tasks like patient registration, verification of eligibility and claims submission become automated. This in turn contributes to both improved staff productivity and patient experience. Another trend to watch is the evolution of diverse ownership models of standalone ambulatory surgical centers ranging from combined physician and corporate ownerships or corporate and hospital group partnerships as well as ambulatory surgical centers owned solely by physicians. These ownership models are changing the landscape in terms of risk sharing, responsibility of revenue generation, expectations of accountability and facilitated business creativity.
Omar Khokhar, MD. Partner at Illinois GastroHealth (Bloomington): Reimbursement continues to be a focus, especially with rising staffing and supply costs. Another trend worth watching is if early career MDs are motivated to invest in an ASC as in years past. If returns continue to drift downward, it may become a challenge to find new investors as late-stage MDs phase out of the workforce.
Philip Louie, MD. Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): 1. Expanding the surgeries that can be safely performed. There will be two main drivers. Enabling technologies must continue to serve as areas of innovation that will improve the visualization, access and safety of our surgeries. Building and fostering ongoing collaborations with our anesthesia colleagues will remain critical in the preoperative care at these ASCs and determining which patients can be effectively cared for. Can we safely expand our indications and provide greater access to care? Will it require a coordinated team effort?
2. Improving our understanding of how ASCs fit into the value-based care equation that is dominating our healthcare landscape. Patient care and outcomes will always be the most important factor. But, in a world where we are seeing a shift to value-based healthcare and reimbursement, we will also need to re-evaluate how spine surgical care is delivered and billed. We need to develop up-to-date evidence to understand the safety, efficacy, and the economic factors are underway.
Raul Rincon Navarro, MD. Founder and CEO at Neuro Spine and Pain Clinic (Panama City, Fla.): Being myself a neurosurgeon trained in minimally invasive spine surgery, including endoscopic and disc replacement, I perfectly see those procedures moving toward ASCs in the majority of cases. It just makes sense. Also, awake spinal surgery is a growing field. Some colleagues are permitting more elaborate surgeries like MIS-TLIF, ALIF, OLIF and discharging the patient the same day, with a very few exceptions when the patient's condition or comorbidities are not suitable.
Richard Rosenfield, MD. Founder and Executive Medical Director at Pearl Women's Center (Portland, Ore.): As a chief medical officer of a multispecialty ASC in Oregon, I'm watching how the major carriers are handling the reduced margins of ASC and looking for an opportunity to exploit value-based care in a way that will truly help the U.S. healthcare economic climate. By reducing complications, avoiding unnecessary surgery and steering patients to quality and cost-transparent centers, there is an opportunity to improve our position as dedicated surgeons without being forced to accept even lower reimbursements as is being proposed by CMS and the hospital systems. While we continue to see major merger and acquisition deals amongst the corporate leaders in healthcare and the verge of monopolies with massive conglomerates, surgeons remain in charge of the quality care we deliver. Someone has forgotten this and opted to pay based on market share, not quality. It's a losing strategy. If we cannot innovate and disrupt, the system will continue to fall apart.
Robert Nucci, MD. Founder of Nucci Medical Clinic (Tampa, Fla.): 1. Unfortunately the increased cost of staffing is likely to continue.
2. More and more procedures that were done inpatient will move to ASCs.
Scott Kulstad. CEO of Chippewa Falls Orthopedics and Sports Medicine (Altoona, Wis.): I'm watching a lot of things, as I am sure are all of my colleagues. But, I am especially curious now about
1. The employer's efforts to actively steer patients toward high-value ASC options in certain markets.
2. The tension that exists when new technologies offer promising therapies with less than certain payer reimbursement and what impact that has on ASC profitability.
Thomas Barnett, MD. Surgeon at Surgical Associates, PA (Dover, Del.): I am watching the anesthesia issue closely. Years ago, we profited a small amount. Now, we are being asked to pay for the privilege of having anesthesiologists at our ASC.
Thomas Campanella. Healthcare Executive in Residence at Baldwin Wallace University (Berea, Ohio): I am watching the trend of services being covered by CMS in the ASC setting. I am also watching the trend of private payers financially incenting members to utilize ASCs for services.
Thomas Moshiri, MD. Chief Business Officer at Arizona Pain Relief and Arizona Pain Specialists (Phoenix): Focusing on the basics of business management, we track our increasing expenses whether it is staffing, supplies and equipment as one trend. We then compare this to our patient input and productivity, specifically focusing on the number of patients scheduled, canceled and rescheduled and the "why" behind any case that is not taken to completion. Combining these two trends we attempt to forecast our current potential profitability as well as future revenues.
Troy Simonson. CEO at Proliance Surgeons (Seattle): 1. The growth in ASC facility ownership by non-provider organizations with a primary focus on volume and profits. Physicians must maintain their ownership and governance in ASCs to preserve the focus on quality and patient experience.
2. The continued innovation with site of service from hospitals to ASCs will be essential in bending the cost trend and achieving value in the delivery of healthcare.