ASCs' biggest enemies to patient care 

Supply chain issues and CMS policies are two of the big obstacles ASCs face in providing patient care. 

Seven ASC leaders joined Becker's to discuss their biggest enemies in patient care. 

Question: What is ASCs' biggest enemy in providing patient care?

Editor's note: Responses were edited lightly for length and clarity. 

Dianna Reed. Administrator of Sani Eye Surgery Center (Templeton, Calif.): Our biggest enemy is not being able to purchase supplies — both pharmaceutical and surgical packs, etc. — at a competitive price point. It is very difficult to compete, especially during COVID-19, for personal protective equipment and supplies against large hospital surgery centers who have a larger buying power. Staffing can be difficult for registered nurses and certified registered nurse anesthetists since we are only open one day a week, but I have resolved this by paying upwards of $25 per hour more than local hospitals. This has helped us attract per diem staff who only wish to work one day per week. Another downside to being an ASC is the reimbursement from insurance companies. We are paid a fourth of what a hospital surgery center is paid and our costs are actually more. 

Cherise Brown. Administrator of Andover (Kan.) Ambulatory Surgery Center: One of the biggest hurdles with an ASC is the patient's general health and not qualifying for an ASC. If a patient has a complicated medical issue or prior health issues, an ASC is less likely to take the patient. Another issue, in the rare event that a complication should arrive during the surgery, the patient may have to be transferred to a hospital.

David Horace. Administrator and owner of Bel-Clair Surgical Center (Belleville, Ill.): Biggest enemy in providing patient care is greedy medical supply manufacturers and vendors that are squeezing the life out of ASC margins as ASC volume rebounds from COVID-19 decline.

Cathy McCue, MSN, RN. Administrator of Uropartners Surgery Center (Des Plaines, Ill.): CMS supports hospitals over ASCs due to a strong American Hospital Association lobby — even though from a value perspective, ASCs provide a much more efficient model for excellent care at a lesser price point. ASCs also have less infections as ASC patients' medical and surgical history can be thoroughly reviewed prior to the surgical date (as all cases in an ASC are elective), and ASCs are limited to an anesthesia score of l and ll (sometimes lll). 

I think the future will be brighter if the hospitals perform all the emergent cases and operate on the high-risk patients, leaving the lower-risk patients for the ASCs, as well as CMS approving  more reimbursements (I may be dreaming).

Andres Duran. Administrator of Brownsville (Texas) Surgery Center:

a. Staffing

b. Limited-service lines

c. Quality-control concerns

Barbara Clancy-Sweeney. Administrator of Gastroenterology & Hepatology at Thomas Jefferson University (Philadelphia): Capital venture groups buying up practices and opening up ASCs. 

Cindy Vasquez, RN. Administrator of Central California Endoscopy Center (Fresno): Appropriate and frequent communication with the patient and family members has been our greatest challenge in recent years. Prior to COVID-19, family members were asked to remain in the center throughout the patient's visit in order to ensure that communication was had with the patient and family members every step of the way. Not allowing for the family members to be at the bedside made for increased patient anxieties, suboptimal communication with family members and instructions less understood. Text messaging helps with those that are tech savvy, but there is still a population that requires more direct communication. Unfortunately, they are often not available to communicate with. We look forward to bringing our family members back into the center soon.

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