ASCs 5 biggest threats in 2023

Nine ASC leaders joined Becker's to discuss the biggest threats to the industry. 

Editor's note: These responses were edited lightly for brevity and clarity. 

1. Increasing operating costs:

Brenda Carter. Administrator of Wilmington (N.C.) Surgcare: With ongoing supply chain issues, increased supply and equipment costs and the ever-increasing need to push salaries higher to remain competitive, there is no shortage of financial challenges.

Daryl Steven Henshaw, MD. Associate Anesthesiology Professor at Wake Forest School of Medicine (Winston-Salem, N.C.): The rising costs of providing care is what makes me the most nervous for the coming year. As the COVID-19 pandemic has demonstrated, supply chain limitations can be unpredictable, frequently happen swiftly and often result in higher product costs. These resultant additional expenses, combined with ongoing inflation and rising staffing costs, not to mention staffing shortages, will likely test the financial stability of many hospitals across the country. While I am optimistic that inflation, supply chain constraints and the job market will all stabilize soon, not knowing if or when this might occur certainly contributes to my current anxiety level.

2. Staff shortages

Ruth Bedwell, BSN. Clinical Director of Sterile Processing at Inova Fairfax Medical Campus (Falls Church, Va.): Resources and talent are harder to come by and the focus should be geared to specialty, not generalist operations. I would think outpatient facilities should join forces and distribute cases based on type but purchase and run as single entities.

John Polikandriotis. CEO of South Florida Orthopaedics & Sports Medicine (Stuart, Fla.): The thing I am the most excited about for 2023 happens to be the thing that I am also the most nervous about, and that is cultivating and nurturing organizational talent. It makes me nervous that many healthcare workers feel they are on a never-ending hamster wheel carrying physical, psychological and emotional weights in a very strained and competitive labor market. The new year is an opportunity to really move the needle towards authentic staff engagement, technology utilization to rethink and retool workflows, and staff empowerment to transition organizations to value creation activities versus continual issue resolution.

3. Reimbursement challenges

Andrew Lovewell. CEO of Columbia Orthopaedic Group (Columbia, Mo.): Entering 2023 we saw Medicare propose another physician pay cut of 4.5 percent; the pay cut has landed on 2 percent. With inflation and rising practice costs, the downward reimbursement trend is not sustainable for some practices. The rate cuts from Medicare aren't the only concern, though. Insurance companies continue to turn in record profits without providing rate increases to practices and facilities. On top of that, the consolidation of practices by private equity is a concern.

Lauren Matteini, MD. Orthopedic Spine Surgeon at Fox Valley Orthopedics (Geneva, Ill.): The challenges we face continue to make me nervous as I see our fees reduced and patient access to providers diminish. Insurance companies continue to dictate the way we practice evidence-based and safe medicine at the expense of the patients they claim to represent.

Joshua Rosenow, MD. Director of Functional Neurosurgery and Professor of Neurosurgery at Northwestern University Feinberg School of Medicine (Chicago): I am tremendously nervous about the reimbursement headwinds. We are faced with a double-barreled CMS cut due to both PAYGO and budget neutrality provisions. These cuts could have a chilling effect on seniors' access to specialty care. Moreover, CMS has yet to remedy the lesser treatment of evaluation and management visits included in surgical global periods since the 2021 evaluation and management code updates. This means that the same outpatient visit is treated differently when performed in the postoperative global period, which does not make sense.

4. Physician pay cuts

John Prunskis, MD. Medical Director at DxTx Pain and Spine and CEO of Illinois Pain and Spine Institute (Barrington, Ill.): The fall in physician compensation by CMS is absolutely irrational, especially taking into account the inflation pressures that medical practices are now under, the complexity of insurance pre-certification and payment systems as well as increasing insurance audits is alarming.

5. Political climate:

Emily Putney, DO. Orthopedic Spine Surgeon at Coastal Orthopaedic and Sports Medicine Center (Port St. Lucie, Fla.): I'm concerned about the political climate that affects insurance decisions regarding patient care. Access to care including imaging, procedures, consults and surgery can be unnecessarily delayed or denied currently, and there doesn't seem to be much improvement anticipated despite efforts. I'm also concerned about perpetually reduced reimbursement rates for common spine surgical procedures, as this affects my private practice's bottom line. Meanwhile, there is no end in sight to increased IT costs including compliance, software and hardware updates for the imaging units and EMR, malware attack prevention, et cetera.

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