As 2023 comes to an end, ASC leaders and physicians are beginning to set their goals for the coming year. Headed into 2024, the majority of leaders are prioritizing ASC and outpatient growth, as well as addressing proposed cuts from CMS and murky payer waters.
These 46 industry leaders explain their top priorities for 2024. The executives featured in this article are all speaking at Becker's 2024 ASC conferences. This includes our 21st Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, which is set for June 19-22 at the Swissotel in Chicago. This also includes our 30th Annual The Business and Operations of ASCs, which is set for Oct. 30-Nov. 2 at the Hyatt Regency in Chicago.
If you work at an ASC and would like to join as a speaker, contact Claire Wallace at email@example.com.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our events. The following are answers from our speakers.
Question: What is your top priority for 2024?
Adam Bruggeman, MD. Orthopedic Surgeon at Texas Spine Care Center (San Antonio): My top priority is working toward a permanent fix to the Medicare physician payment system. We have gained significant momentum and awareness on the topic in Washington, D.C., and recently had the chair of the Senate Finance Committee state that their committee would need to address the issue next year. Meaningful reform with a tie to the actual cost of providing care is needed to ensure access for patients and the long term viability of physician practice.
Adam Roggia. CEO at Sports Medicine Associates of San Antonio: Top priority for 2024 is navigating the challenges of expanding infrastructure, development and culture against the ever-changing environment of insurance and regulatory concerns. We have growth and expansions to do, and we want to do them while maintaining and improving our teams' cohesion and resilience.
Alfonso del Granado. Administrator and CEO of Covenant High Plains Surgery Centers (Lubbock, Texas): My top priority for 2024 is expansion. One of my centers is at 107% of nominal capacity, and I can't grow any further without adding another operating room. Another center is below capacity but lacks larger rooms to start doing total hips, so we will be adding two large rooms and converting smaller rooms to storage. Finally, with CMS' sudden unexpected release of total shoulder arthroscopy to the ASC covered procedures list, I find myself scrambling to meet with our surgeons and staff to begin planning for the first of the year. This is an exciting time and I haven't felt this bullish about the future since before the COVID pandemic.
Andrew Lovewell. CEO at Columbia (Mo.) Orthopaedic Group: 1. Recruit and retain top talent:
We are looking to stabilize our workforce on all fronts. Attracting and retaining top talent is essential for us to continue our growth strategy. In an extremely competitive labor environment, getting the right people in the door is important. We have overhauled our benefits package recently and are continually working to provide the best benefits to our staff. We are still facing critical shortages in anesthesia providers and diligently working to assure we are in the best position to recruit the top talent in the market in this field as well as all others.
2. Payer contracts and steerage:
With the inflationary curve on the rise and another looming cut to the physician fee schedule, it is imperative that we re-examine our payer contracts with all other payers in our market. Many of the Medicare Advantage plans in our market are trying to pay below the Medicare physician fee schedule, and none of them are accounting for the implant costs associated with doing surgery in our ASC. I am also looking for steerage from the payers for ASC strategies in our market. As the low cost/high value provider in the market, we should see significant streerage to our facility but have not experienced that yet. With our clinical outcomes both surgically and non-operatively, we are the best value around.
We are continuing our growth strategy of bringing on high quality surgeons and non-operative providers in our market. In addition, we are working on improving patient access and convenience by adding more adjacent services to our organization to improve the patient experience in our facilities. We have added lab services to our already existing offerings, and patients have really appreciated the opportunity to have a comprehensive offering.
Andrey Ibragimov, BSN, RN. Director at Ingalls ASC (Chicago): In 2024, my primary focus is on nurturing and retaining our exceptional team. We understand that the quality of care we provide is directly linked to the dedication and expertise of our staff. To ensure our center remains a rewarding and supportive workplace, we're enhancing our strategies and policies. Concurrently, we're actively seeking to collaborate with UChicago Medicine academic surgeons, acknowledging the increasingly competitive healthcare landscape in the Southwest suburbs. Our goal is to create an environment where outstanding healthcare and fulfilling career paths flourish together.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: My top priority for 2024 is to increase my focus on patient experience, endoscopic spine surgery and my efforts in patient and physician advocacy. With the recent cuts to reimbursement by siloed bureaucracy, seemingly in the favor of the payers, it is more important than ever to shine a light on the real forces that drive the increase in the cost of healthcare. In my own practice, we are focused on having physician-led care with high levels of contact with the patients and clarity of their care plans, with good outcomes, happy patients and the same attention to detail our patients are accustomed to. Truly minimally invasive surgery for selected cases will drive good outcomes, and I think will lead to more outpatient cases and patients convalescing comfortably at home sooner after surgery, when it is safe and appropriate.
Dan Chen, MD. Assistant Professor of Orthopedic Surgery at Geisinger Commonwealth School of Medicine (Scranton, Pa.): 2024 will be a year of growth for hospitals and physicians alike as we return to normalcy after the COVID pandemic, and as the aging U.S. population begins seeking increased elective procedures to treat their ailments. My top priority continues to be the best minimally invasive spine surgeon and physician that I can be for my patients, and to provide them with individualized care to maximize their return to function. Product innovation, coupled with integrating the evolving body of knowledge, will be critical to providing the best spinal treatments. Along these lines, I think the spinal implants industry will continue to advance and innovate in 2024, and I'm looking forward to what new technology is available to my patients.
Earl Kilbride, MD. Orthopedic Surgeon at Austin (Texas) Orthopedic Institute: My top priority for 2024 is to work smarter, not harder. Being 22 years post residency, I feel as though I have optimized the clinical workflow side of practicing orthopedics. The administrative is another story. We can all document better, empower our team and streamline that side of the practice.
Eric Mehlberg, MD. Anesthesiologist at Comprehensive Pain Specialists (Golden, Colo): My priority for 2024 is to continue diversifying my skill set. This serves a couple aims. One, it prevents one's practice from getting stale. Two, it makes you attractive to referrers and employers, and three, it serves our patients better.
Erin Vitale, RN. Director of Nursing at Hoffman Estates (Ill.) Surgery Center: I have so many as the new director of nursing for this center, but if I had to narrow it down to just one, I would say that my focus will be to continue to grow our center not only in case volume, but also in what we offer as a multispecialty center. As we have plans to kick off our total joint program in the beginning of 2024 with total knee arthroplasties, I would like to see that service line grow into shoulders and hips as the year goes on. We also have a general service line that has a great opportunity to expand its services. As we grow we will continue to offer the same quality, safe care we have always provided with the amazing team we have built here.
Fawn Esser-Lipp. Executive Director at the Surgery Center (Franklin, Wis.): My top priority is getting total shoulders started now that CMS has approved coverage. I will need to work on getting instrumentation, procuring equipment and staff training. Of course, monitoring expenses is always at the top of my list.
George Bovis, MD. Neurosurgeon at Ascension Illinois (Chicago): In 1999-2000, we thought computers were too dumb to handle the millennial change. In 2023-2024, we think computers/AI are too smart and pose an existential threat to mankind. So in 2024, I look forward to reconciling how this promethean technology can be harnessed to safely and intelligently optimize patient care and outcomes.
Grant Booher, MD. Neurosurgeon at Longhorn Brain and Spine (Fort Worth, Texas): My goal for 2024 is practice growth. I have partnered with a management group and several local surgeons to build out an ASC. I'm utilizing robotics and plan to focus on endoscopic approaches with regional blocks for more outpatient surgeries. I'm currently a solo practitioner and I would love to bring on a like-minded physician partner this next year as well.
Heather Liester, MSN, RN. Director of Pain Management at OSS Health Pain Center (York, Pa.): Our organization is implementing a new EMR. My priority is building our new EMR system to ensure more efficient workflows within the system to better care for our patients and to be able to communicate more efficiently with other healthcare systems.
Jacob Rodman. CEO at Raleigh (N.C.) Neurosurgical Clinic: My top priority for 2024 is to focus on and maximize operational efficiency. Balancing a private neurosurgical practice and an ASC with declining reimbursement and more challenges every day with prior authorizations, we have to get better in 2024. Learning how to maximize AI and automation will be on the top of our minds. Unfortunately, I do not see the landscape changing anytime soon for surgeons, so we have to maximize what we can do on the operational side of healthcare. With all that said, I think the future is still very bright for ASCs and especially spine- and pain-focused ASCs.
James Chappuis, MD. Orthopedic Surgeon at Spine Center Atlanta: My top priority for 2024 is community building. Creating new bonds around Atlanta and our satellite locations fortifies my purpose to help others get back to the life they want to live without pain. I look forward to expanding our practice in areas where pain is a living constant due to the lack of resources and providing an alternative solution to solve the problem instead of placating it.
Jami Osterlund, MSN. Perianesthesia Manager at Houston Physicians' Hospital: We are currently in a strategic growth plan for the ASC that includes adding another operating room and expanding our service lines to better support our patients and community. My top priorities for 2024 include effective physician on-boarding, staff recruitment and retention, and managing efficiency in patient flow despite construction and unforeseen roadblocks.
Jayesh Dayal, MD. Anesthesiologist at White Flint Surgery (Rockville, Md.): As an independent ASC, as we transition to the higher acuity ortho and spine cases, it is becoming very apparent that remaining independent is becoming impossible, as we have absolutely dismal rates, no scope of negotiating anything at our scale — with the insurers or the vendors — and the personnel costs are out of control. For 2024, we have started talking to national chains, private equity firms and hospital systems to partner with so that the rates get better, the cost of disposables and implants get better, and the day to day operations and RCM are optimized. The days of in-house billing, long-term relationships with one's team, the independence to run your own outfit, are sadly gone. It was fun while it lasted, but it's time to bring in the suits — like the hospital days of yore.
Jeff Dottl. Principal at Physicians Surgery Centers (Ventura, Calif.): My company has experienced some pretty fast growth over the past two years, despite the myriad challenges we are all facing. In 2024 I see two primary focus areas. One is on the turnaround facilities we've picked up recently. Correcting bad habits and getting them "lean and mean." The second is continuing to develop our hospital joint venture partnerships to more fully enjoy the benefits those relationships can offer. 2024 is going to be a big year.
Joe O'Brien, MD. Medical Director of Minimally Invasive Orthopedic Spine Surgery at VHC Health (Bethesda, Md.): Our top priority for 2024 is to grow our ASC with another room.
John Brady. CEO at Fox Valley Orthopedics (Geneva, Ill): For 2024, clearly continuing to provide the highest quality care possible is our goal. To do this we are looking at workflows across the ASC in order to develop more efficient processes and resource utilization, ultimately ensuring an optimal patient experience. We are focused on all areas of the care, supply chain and revenue cycle processes from initial scheduling and verification through the case to follow-up visits and billing. By tightening these processes, we believe we will increase access to our services by getting the most out of our resources.
Johnny Russell. Director of Area Operations at Sutter Health (Sacramento, Calif.): In 2024, we will continue to focus on improving access to surgical care in the communities we serve. We're looking at better meeting patients' needs in a number of ways, including expanding ASC hours, hiring more staff and optimizing time-saving workflows and technologies.
Jon Schmidt. Vice President of Operations at Rothman Orthopaedic Institute (Orlando): The top priority for Rothman Florida in 2024 is to continue to expand and meet the growing need for subspecialty orthopedic care in Central Florida. Through our partnership with AdventHealth, we are able to collaboratively work to assess the needs in each sub-market and recruit accordingly. It is a dynamic time in our market with a rapidly growing population, and we are looking to position ourselves to meet that need.
Judy Wolfe, MD. Enterprise Associate Chief Experience Officer at Cleveland Clinic: Over half of the patients seeking care nationally run into operational friction — barriers to care that frustrate and degrade loyalty in the system and caregivers. A top priority in 2024 is to help make getting care at Cleveland Clinic easier. As an enterprise, we're reinvigorating communication skills and service behaviors in all care settings, empowering caregivers to remove obstacles to care, and illuminating opportunities to improve processes and procedures with the patient at the center of our efforts. Technology, retail and hospitality have focused on ease as part of the customer experience for years — it's time for healthcare to adapt, too.
Justin Bundy, MD. Orthopedic Spine Surgeon at Augusta-Aiken (S.C.) Orthopedic Specialists: My top priority for 2024 is to advance outpatient spine with new technology and patient-appropriate care.
Ken Rich, MD. President at Raleigh (N.C.) Neurosurgical Clinic: I would like to see insurers including Medicare allow surgeries that can be done in ASCs to be done there. All too often I find our group doing surgeries in a hospital at three or four times the expense that easily could be done in an ASC. The insurers would save a lot of money, and the patients would have a much better experience.
Kenneth Nwosu, MD. Spine Surgeon at Neospine (Puyallup, Wash.): My top priority for 2024 is to transition "higher acuity" spine procedures like transforaminal lumbar interbody fusions back to the ASC. These procedures were routinely performed safely in the ASC for Medicare beneficiaries due to provisions from the Hospital Without Walls program announced by CMS in March 2020 due to the COVID-19 pandemic. However, as the pandemic abated, so did the HWW program and its associated provisions, making it cost restrictive to perform these procedures in the ASC setting.
Currently, a majority of these patients are discharged home on the same day of surgery when performed in the hospital setting, but at a higher cost. Rather than wait and hope for CMS to recognize and address this discrepancy in value delivery, we plan to demonstrate the discrepancy empirically in our experience, with hopes we will be granted a carve out to begin performing these "higher acuity" spine procedures in the ASC again.
Kristin Ward, RN. Vice President of Surgical Services and ASC Administrator at OSS Health (York, Pa.): Our organization is developing and implementing an EHR organizationwide as well as opening up the second ASC for our organization. We just started outpatient total joints with success and will continue to work to improve efficiency and best practice. Our anesthesia group is part of our organization now over the last year, working to continue to build programs and build on collaboration.
Larry Trenk. Vice President of Operations at Physicians Endoscopy (Jamison, Pa.): Identifying opportunities for growth.
Manoj Mehta, MD. Medical Director at Endoscopy Center of the North Shore (Wilmette, Ill.): 2024 will see another year of shrinking reimbursements, a declining available physician pool and increasing patient health needs. While I anticipate that hospital systems will respond in the usual way (cutting appointment times, squeezing doctors for more productivity, slashing salaries and letting patients wait times languish), this is an opportunity for the more flexible private practices and outpatient surgicenters to fill the void. We plan to increase our availability, provide more endoscopy slots and onboard new physicians to meet these needs. I would encourage all of you who have your own practices to take ownership of the needs of your patients in this next year more than ever. These efforts are not unrecognized, and pay dividends in patient satisfaction scores, new referrals, reputation and even your own satisfaction with work.
Marco Araujo, MD. Anesthesiologist at Advanced Pain Management (Green Bay, Wis): Starting a new pain practice and a new ASC in Stevens Point, Wis.
Michael Boblitz. CEO of Tallahassee (Fla.) Orthopedic Clinic: TOC's top priority is to outrun ongoing Medicare cuts and labor inflation through our continued double-digit annual revenue growth realized through our strategic plan, Vision 2030. Our physicians work at/near the 100th percentile and cannot be expected to burn out, so our plan reflects a combination of a much broader geographic reach through aggressive de novo investments in new markets such as Panama City, where in just one year we already have five physicians and North Florida's only orthopedic urgent care. In addition, the strategy focuses on increasing the percentage of our overall surgical cases performed in one of our ASCs to 70%, as well as increasing our percentage of ancillary revenues to 25% of our practice — the aim …. supporting the purchaser/employer mandate to reduce the overall cost of care while also reducing fragmentation of care across multiple settings and electronic health records. To execute on this plan we have or will soon be breaking ground on investments to double our 1. MRI machines; 2. physical/outpatient rehabilitation services; 3. orthotics and prosthetics program; and 4. building a specialty ASC that focuses only on spine and joint replacement surgery to include private recovery rooms with private bathrooms for those patients requiring an extended stay.
Millie Mardahay, BSN, RN. Director of Nursing at East Bay Endosurgery (Oakland, Calif.): Top priority for 2024 is nursing staffing retention with the focus on work-life balance, educational opportunities and career growth and advancement. These may sound like clichéd punchlines, but in reality it's pretty hard to pull off given the competitive edge hospitals have over ASCs; however, building a unique culture is essential.
Nyleen Flores. CEO and Administrator at Total Surgery Center (Naples, Fla): Continuing to streamline all processes and focus on growth in the ASC space to maximize utilization.
Omar Khokhar, MD. Partner at Illinois GastroHealth (Bloomington): Top priority is staff engagement to meet our goals. Historically we haven't enrolled our staff into the why — the patient experience, the revenue cycle and bottom line. We need to find the right staff who are willing to understand the why and then choose to walk the walk with the ASC in order to improve patient access and profitability. We also need to be more aggressive and proactive with contract management/optimization.
Pankaj Vashi, MD. Department Head of Gastroenterology/Nutrition and Vice Chief of Staff at City of Hope Chicago: My priority for 2024 is to see the impact of AI in the field of gastroenterology. Artificial intelligence is in its infancy, and we are already seeing it being used for screening for colon cancer and surveillance for Barrett's esophagus. New applications of AI will change how we practice in the near future.
Paul Bruning. Service Line Director at Sutter Health (Sacramento, Calif.): Continuing to develop, implement and monitor patient-reported outcome measures is imperative in the orthopedic space. As more procedures move into the ASCs, demonstrating the quality of care, through use of PROMs, augmented with the cost comparison and savings, will influence future payment structures, including value-based payment models. Having data that supports the value permits leverage in contract negotiations with payers and improved development of VBPM that are not theory but developed from actual patient and cost analysis data.
Peter Passias, MD. Orthopedic Spine Surgeon at NYU Langone Health (New York City): Top priorities are expanding AI applications in spine surgery not just in the OR but in terms of patient selection, risk stratification and predicting outcomes. Also diminishing invasiveness options are expanding with advanced technologies, and traditional surgery is becoming minimized.
Rebecca Urban. System Director of Orthopedics at Summa Health (Akron, Ohio): I suspect that 2024 will be faced with staff retention, increasing expenses and reimbursement cuts — similar concerns of 2023. We will need to stay nimble and find ways to thrive among the clouds and potential "rain." The looming future of reimbursement cuts, increased expenses and staff retention will require us to respond in ways we haven't in years prior, by partnering across service lines to reduce the cost of care and advancing our mission to serve our community. It will be a year of opportunity — we will stay nimble, focused and remind ourselves it's a marathon, not a sprint.
Reuben Gobezie, MD. Director of the Gobezie Shoulder Institute in Cleveland: Incorporate our ASCs into our overall practice strategy to provide risk-based contracts to payers and employers in order to reduce their total cost of musculoskeletal spend. We are using provider-based technology platforms like Genie Health to enable our practice to leverage all of its services to the payers and self-insured employers who are desperately seeking ways to reduce their ever-increasing MSK spend. Surgical procedures are amongst the most expensive services MSK practices provide, and the ASCs are an ideal ancillary to leverage in any strategy to reduce the total cost of care for musculoskeletal care.
Robert Bell, MD. CEO at NW Surgery Center (Houston, Texas): The main priority for our surgery center in 2024 is to continue to market and promote our liability business.
Sarah Sterling. Area Administrator at Sutter Surgery Center Division (Sacramento, Calif.): My top priorities revolve around three key areas: increasing patient access, introducing new procedures and service lines, and optimizing operational efficiencies. By focusing on these priorities, it will provide greater accessibility to our services, expand our offerings to a broader population and our community. Introducing new procedures and services lines enables us to meet the evolving needs of patients and stay competitive in the healthcare landscape. Additionally, optimizing operational efficiencies helps us deliver high-quality care in a cost-effective manner, ensuring the long-term success of our centers. These priorities collectively drive our commitment to delivering accessible, comprehensive and efficient healthcare services.
Scott Sigman, MD. Surgeon at OSA Orthopaedics (Chelmsford, Mass.): My top priorities in 2024 are to identify solutions to improve the quality of life for physicians. Everyday we are asked to do more with the ever present threat of getting paid less. Physician burnout must be addressed. We need to leverage technology to our advantage to improve physician time management. We need to identify alternative revenue sources that also benefit patient care, such as companies that are utilizing remote therapeutic monitoring codes. I will continue to work on my passion for alternative pain management options for our patients to keep them moving so they can champion their personal success.
Sheel Patel, MD. Anesthesiologist and Interventional Pain Specialist at APAC Centers for Pain Management (Chicago): Top priority for 2024 is to have our two ASCs at 75% capacity in terms of the number of days we have surgeons performing cases. We are currently only providing interventional pain services; however, the idea is to expand into podiatry and possibly ortho cases as well. Additionally, we hope to start offering ketamine infusion services in the ASC on days where we do not have any surgeons performing cases.
Taif Mukhdomi, MD. Pain Physician at Pain Zero (New Albany, Ohio): Growth! There is a changing tide in physicians across the country as young physicians are assuming the roles of their seasoned counterparts. There is new energy behind young physicians eager to shape healthcare: excitement to help patients, offer new and innovative therapies, understanding of the healthcare industry and are poised for growth. We are looking to grow our presence in the national and regional healthcare spotlight, build on our clinical team, and expand our care across the Columbus and Central Ohio area.
Timothy Lubenow, MD. Professor of Anesthesia and Pain Medicine at Rush University Medical Center (Chicago): I'm planning to improve my payer mix by networking with workers' compensation nursing organizations. I also am limiting the number of Medicare patients seen on a daily basis.