The biggest threats ASCs are facing in 2023

Issues including staffing shortages, payer reimbursements and hospital/health system competition are putting pressure on ASCs in 2023. 

Question: What are the biggest threats facing ASCs this year? 

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

Jess Huckins, BSN, RN. Administrator of Black Hills Surgery Center of Wyoming (Gillette): Declining insurance reimbursement is the biggest threat. 

John Stewart. CEO and Founder of Total Spine & Orthopedics (Melbourne, Fla.): The biggest threat that our surgery centers are currently facing in the state of Florida is the monumental insurance tort reform House Bill 837 that Gov. Ron Desantis wants to pass. There are many points in the bill that pose a threat to Florida families, and the attorneys that zealously defend them, but the threat to Florida ASC owners are the proposed standards for the costs of medical care for personal injury patients. These costs include Medicare reimbursements or potential payments based on the Medicaid fee schedule for injured patients. 

For any ASC in the state that helps patients that have been injured in an auto accident, they should be prepared to accept Medicare rates, at best, for their services. Many of our Total Spine & Orthopedics ASCs offer cutting edge spine, orthopedic and even brain surgeries that contain codes that do not have a Medicare reimbursement allowable in an ASC. Under this new bill, these ASCs will be paid according to the Medicaid fee schedule. I can't think of any physician or business owner that is motivated by, or even satisfied with, accepting Medicaid for their services.  

Justin LeCompte. CEO of Virtuous Health Centers (Phoenix): The biggest threats we see are still the same as last year and the years prior; increased costs of doing business versus decreased reimbursements. Commercial payers continue to be a major threat to the entire healthcare industry by requiring pre-authorization, denying payments on the back end for medical necessity and continuously [making] low ball, borderline offensive offers for in-network contracts. I hope to see more providers leaving networks so we, as a medical community, can stand together and demand more fair and reasonable compensation.

Margaret Chappell. Manager at Center for Advanced Surgery (Ladson, S.C.): Surgeons, now more than ever, are employed by healthcare conglomerates, which can steer their cases to facilities they own. This leaves ASCs little ability to recruit and grow.

Michael Powers. Administrator of Children's West Surgery Center (Knoxville, Tenn.): I think the biggest threat towards ASCs in 2023 is staffing, especially qualified, experienced staffing in all areas of an ASC, including business office, pre-op, OR (both nursing and surgical technicians), post anesthesia care unit and recovery nurses. In addition, sterile processing technicians. Each of these areas require a certain set of skills that are acquired and honed over time. There is increased competition, and in fact it is hard to compete with large health systems/hospitals. I am also finding that ASCs are competing in the same region against one another for the available staffing pool.

This creates the constant awareness of what it takes to not only be competitive with compensation and benefits, but to align the potential employee's goals to your center's culture and how they can best be happier in your facility. Lastly, this can cause internal morale issues if you hire in staff at equal or higher rates as your long term employees, so a plan to address compression and communication is key.

Noel Rayatkah. Director of Operations at Premier Surgery Center (Concord, Calif.): The biggest threat to our busy, physician-owned, multispecialty ASC is the rising costs of everything. On top of that, insurance carriers are not willing to negotiate contracts that reflect the rising costs of business. Our payroll has gone up by over 20 percent in the last few years, and our contracts are stuck in low percentage increases every year that do not even cover inflation. The payers are negotiating rates at hospitals that cover big hospital costs but leave ASCs to count every dollar for each case.

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