'We want to be compassionate as well as responsible': What we heard this month

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Healthcare providers have given Becker's insight on a number of topics, ranging from staffing, procedural growth at ASCs, to vaccine mandates.

Sixteen insights shared with Becker's this week:

Why 1 center 'proceeds with caution' in payer contracts
Grant Foley, executive director, Midwest Center for Joint Replacement (Indianapolis): With the high number of sales calls we receive from dealmakers in the market, it's always tough to gauge the true volume or value an agreement will bring to an organization. Most of them are simply searching for the lowest-cost procedure and are unable to deliver much in return. All opportunities are worth hearing, but we approach each conversation cautiously — wanting to make the right decision for our future. A seemingly good deal now to gain a little surgical volume could prove otherwise down the road, so we proceed with caution. The key for us is to find the right partner that is a good culture fit and are like-minded with the goal of creating a win-win relationship. Our organization and surgeons also make an effort to stay in contact with the leadership of the major payers in our local area. With being focused on joint replacement, we feel this is an area of opportunity for a center such as ours. But for now, we are simply vetting each opportunity one at a time.

3 key issues in gastroenterology
Larry Schiller, MD, board of directors, Digestive Health Associates of Texas (Dallas): Private equity organizations will continue to vacuum up private practices throughout the country as older gastroenterologists see the potential to cash out. The challenge for PE organizations will be to use their scale to build value, but expenses can only be cut so far without impacting the quality of services. Competition from hospital or medical school-based practice groups eventually will limit the growth of PE organizations in larger communities. Consolidation of PE organizations will be the next stage of growth for these businesses, with disposition of these larger entities uncertain at present. Possible outcomes include going public with an initial public offering of shares once a critical size is reached, or sale to health care systems or private insurance companies. For gastroenterologists individually, salaries should be stable for the near term, but opportunities to profit from ancillary services may be limited.

Nurse recruitment, retention is a No. 1 priority for ASCs in 2022
Brock Kreienbrink, MSN, RN, administrator, Outpatient Surgery Center of Central Florida (Wildwood): We are a cardiac-only facility, and our staff are highly specialized. COVID-19 has created travel opportunities for these employees at unheard-of prices. The combination of staff leaving our market at significant levels and the increase of ASCs/catheterization labs/hospitals in our market is draining the staffing pool — which is causing major inflation in the staffing cost to compete for these employees.

6 ASC administrators on staffing challenges
Linda Deeming, center director, Salud Family Health Centers (Fort Lupton, Colo.): In the next six months, staff retention is at the top of our list. Those who were not furloughed during COVID-19 are feeling exhausted from doing duties other than their regular assigned positions. Those who were furloughed or laid off are not ready to come back to work for a variety of reasons. As we have started operations toward a more normal mode, we are certainly struggling with getting up to normal staffing and keeping the trained staff we currently have. The budget is also a concern; it's certainly a balancing act that is not easy at this point.

'ASCs can help large systems,' administrator says on hospital partnerships
Zachary Welch, administrator, Wake Orthopaedics (Raleigh, N.C.): We will see a significant increase in partnerships between ASCs and hospital systems. Contract negotiations, supply/implant costs and addressing increasing regulations are all areas these partnerships are likely to mutually benefit from, while also addressing payer requests to move various procedures out of the hospital to the ASC environment. ASCs can help large systems address efficiency opportunities while also serving as a focal point for additional innovation and expansion of various services.

Are COVID-19 surges affecting ASC growth plans?
Andy Wilkinson, director of ASC strategy and business operations, Shields Health Care Group (Quincy, Mass.): COVID-19 has caused a great deal of disruption across the healthcare system and has delayed a number of our growth plans. While our volumes have returned to pre-pandemic levels, there’s still a feeling among our surgeon partners that the reduction in extracurricular sports, in both the school-aged and adult populations, has impacted potential growth in our sports medicine volume. That said, we strongly feel that ASCs provide a welcoming environment for patients, and because of our commitment to partnering with community providers, our patients have the opportunity to access the care they need close to home and without long commutes to appointments. Because of this, we anticipate that we will see a positive impact on the growth of our ASCs over the next few years.

How 7 ASCs are focusing on growth
David Silvernale, CFO of MNGI Digestive Health (Minneapolis): We continue to see an increase in demand for high-quality endoscopy procedures performed in our ASCs. This has resulted in the development of two new four-procedure room endoscopy centers that will open in 2022. These centers will provide additional capacity to meet the demand for services that continue to increase due to the lowering of the recommended CRC screening age and value-based and shared-savings contracts. This has led to the potential for partnership opportunities with local health systems that continue to look for ways to lower the total cost of care and free up their hospital surgical space for services that are appropriate for the site of service. We are also currently looking for the appropriate space to add an additional endoscopy center in 2023.

CON laws pushing cardiologists to open office-based labs over ASCs, CEO says
Krishna Jain, CEO, National Surgical Ventures (Chicago): That's the only way you can open more ASCs and provide better care to the patients at a much more reasonable price. Some of the states where a certificate of need is not required, such as Texas, have more ASCs compared to some of the states where the certificate of need is required, such as New York or Michigan, where growth of these ASCs is much more restricted. However, cardiologists do not need a CON when they're working in the office space level. Because of this, we've seen many more office-based labs opening around the country than ASCs.

Top fears for ASC execs
Matthew Ewasko, administrator, Physicians Alliance Surgery Center; surgical services business analyst, St. Francis Healthcare System (Cape Girardeau, Mo.): I'm most nervous about dealing with commercial payers. They're looking at their bottom line as much as we are, so trying to enter into negotiations with them is always a bumpy process. I want to make sure we have all our information to support our side of things as my No. 1 priority. Another issue we've been dealing with in the past several months is staffing shortages. I know that's common across the country, and it's not just for ASCs. Hospitals are hurting as well. Staff recruitment and retention is something we are trying to keep an eye on.

9 ASC leaders on vaccine mandates
Jonathan Kaplan, MD, owner, Pacific Heights Plastic Surgery (San Francisco): This is a pandemic of the unvaccinated. That's the only reason it's been able to break through in the few cases for the vaccinated patients. Far and away, most people in the hospital are unvaccinated COVID-19 cases, so we are going to do our small part [to stop the spread]. If you're coming in for a procedure, cosmetic or reconstructive, you have to be vaccinated. It keeps our employees safe and their families safe, and I think it's also safe for all the patients coming in to minimize the chances that we have a delta variant in our office.

6 physicians share their best career decisions
David Sun, MD, PhD, Norton Healthcare (Louisville, Ky.): Medical school, graduate school and residency are rigorous and challenging, but extremely narrow in focus. We learn nothing about healthcare economics — how hospitals run, how an office is managed, how doctors get reimbursed. To really understand the industry, it's all on-the-job training and seeking out opportunities. If someone asks you to sit on a hospital committee or work on an administrative project, say "yes." First, it's the best way to challenge yourself to learn new things. Second, if you say no, they're never going to ask you again. It may be intimidating to be outside of that narrow focus, but the best decision that I made in my career was to say "yes."

Standalone ASCs can stay competitive through recruitment strategy, 1 CEO says
Lisa Cooper, CEO, Santa Cruz (Calif.) Surgery Center: The continued trend of consolidation will make it an even tighter staffing market. The race to recruit and retain staff will become stiff with large management companies having their own staffing registry to flex up and down as needed. Standalone centers with fewer than 30 employees will need to be resourceful to remain relevant and attractive to the continued shrinking market of experienced operating room nurses and scrub techs. This staffing crisis has been compounded with COVID-19, as many households have made dramatic changes with the living situation and educational plans. Looking back, having busy surgeons has always been key to attract talent and remain competitive in this market. Going forward, having busy surgeons will not be the key driver — stability with staffing and ongoing training programs will be critical to future success.

Texas ASCs brace for hospital spillover, but another PPE shortage could spell disaster
Alfonso Del Granado, administrator, Covenant High Plains Surgery Center (Lubbock, Texas): Last year we had an unacceptable number of patients who delayed necessary treatment and ended up needing more invasive, riskier procedures, and I would not want to repeat the cycle. While hospitals should take reasonable steps to protect their populations, the overwhelming weight of the responsibility must fall on the governor's shoulders, and I would hope he will also take reasonable steps to protect those same populations.

Florida proof of vaccination ban burdens ASCs as COVID-19 surges
Robin Yeager, RN, director of operations and COO, Advanced Ambulatory Surgery Center (Altamonte Springs, Fla.): The challenge in Florida in comparison to the California ruling is the contradiction to the executive order restricting businesses from asking for proof of vaccination. We had seen a decrease in patient satisfaction when visitors were not allowed to be in the surgery center while the patient was being treated. People want to be present and available when loved ones are having invasive procedures. We want to be compassionate as well as responsible, which is becoming increasingly difficult as the variants of the virus continue evolving.

ASC owners are retiring early; what's next?
Karen Albright, nurse administrator, Riva Road Surgical Center (Annapolis, Md.): We had to rearrange the mindset of the older physicians who originally were doing all their complex cases in the hospital and say it's OK, just because you're doing what you've always done doesn't mean you have to continue. You can be a trendsetter, and you can move to the outpatient arena, as many procedures are under the fee schedules now. The longevity of the center and long-term goals and planning are very important when you consider the outpatient arena.

What's worrying ASC leaders?
Ashley Fernandez, administrator, Arrowhead Endoscopy & Pain Management Center (Glendale, Ariz.): With the COVID-19 case rates rising across the country, I feel we are in a better position compared to last year. We were forced to shut down last year in order to preserve hospital bed capacity and personal protective equipment supply. The hospital systems have more systems in place compared to last year to handle surges and supply chain issues. With that said, I would be lying if I were not concerned about what the next six months will look like. Our main focus is to secure PPE supply and to continue the necessary mitigation efforts to prevent an exposure at our ASC, as well as continuing to make adjustments whenever changes come down the pipeline during the pandemic.

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