What will make — or break — ASCs in 2023?

Four practice management specialists joined Becker's to discuss what they believe will determine the success or failure of ASCs this year.

Q: What will make or break ASCs in 2023? 

Editor's note: Responses have been lightly edited for length and clarity. If you would like to contribute to our next question, please email Paige Haeffele at phaeffele@beckershealthcare.com.

Sandy Berreth, RN. Surveyor for the Accreditation Association for Ambulatory Health Care: This year will be a telling one for ASCs. We have heard that hospitals want to joint venture and we have heard that payers want to move cases to the ASC arena. However, those situations are happening at corporate management levels. While those moves are perceived as helpful to ASCs, it hardly affects the hometown ASCs that are not involved with corporate leadership. There are still small organizations all over the country that have substantially difficult relationships with their local hospitals. Often these same organizations find it difficult to deal with payers. There are some organizations where payers won't even talk with them, and to negotiate for better payments is not an option. How discouraging is that?

Here's the thing: Without better partnerships between physicians and hospitals and better payments from Medicare and commercial payers, the hometown ASC arena will not be able to financially compete with their hospital counterparts, at least for the ASCs that do not have management corporate leadership.  

Major concern: Staffing should be under 30 percent of your total expenses. With staffing expenses increasing, including benefits, these benchmarks are difficult to maintain. The staff currently working at ASCs may have a wonderful environment with great leadership, but money becomes an overriding consideration and as hospitals are starting to recognize these attributes, they are starting to recruit to the hospitals. For example, 12-hour shifts mean three days a week, often staff can work four to six days in a row and have four to five days off in a row. Other aspects of hospital staffing are changing as well. Some hospitals are offering weekends only; just think, a staff person can work the weekend and have the entire week off to be with children or pursue another career option. The options, if the hospital desires, are endless and with a better compensation package. No longer days, no weekends and no holidays attract staff. 

So ultimately, the answer to your question, what will make or break ASCs is simple. People — it is all about people.  

During the last year I have been to many ASCs and many of them are struggling. Their biggest challenge is staffing; without staff, you can't provide quality care.

Tara Graf. Administrator of Salmon Surgery Center (Silverdale, Wash.): Availability of anesthesiologists. It is affecting all of our centers in Washington. There are not enough for them to go around and the hospitals are offering them more than private practice for ASCs. 

Trey Sampson III. Administrator of Newport Beach (Calif.) Surgery Center: ASCs continue to face significant challenges in 2023 that could make or break our success. There are four critical factors that I feel deserve the highest urgency in addressing. 

One of the most critical factors is staffing challenges, which remains a major issue in 2023.  With an ongoing shortage of skilled healthcare professionals, we struggle to attract and retain talented staff members. This could, and often, leads to longer waiting times for patients and physicians on the date of service. Not only would that be poor customer service to our patients and providers, but it may lead to decreased quality of care. To succeed, ASCs must prioritize staff retention AND invest in training and development programs to attract top talent.

ASCs must also struggle to manage the cost … especially concerning medical supplies and drugs. The ongoing global pandemic continues to disrupt the supply chain, causing an increase in demand for needed supplies as ASCs compete with hospital allocations. This shortage increases the possibility of canceled procedures caused by lack of supplies or increased cost for supplies we are able to procure.

Reimbursement rates will play a crucial role that can affect the financial viability of the center.  Reimbursement rates have remained low for years and some ASCs are seeing moderately declining rates in 2023. This is putting significant pressure on ASCs to be proactive in reimbursement negotiations to secure more favorable rates while exploring new ways to improve our revenue cycle management processes and efficiency.

As if the above two factors are not daunting enough, ASC competition is becoming increasingly fierce as ASCs must find ways to differentiate themselves from competitors. Patients are more proactive in their healthcare than ever before and are becoming more selective in their choices of healthcare providers. They want providers who offer high-quality care at affordable prices while having a positive patient experience. This can be a tall bill to fill, but ASCs must be able to focus on delivering exceptional patient care, cease opportunities to bring newer technology to the operating room and seek new partnerships and collaborative relationships to survive.

ASCs continue to face significant challenges in 2023, but if we focus on staffing, operational expenses, reimbursement and competition, we can position ourselves for a successful year while struggling to survive in a rapidly changing outpatient service environment.

Taylor Vazquez. Administrator of Minimally Invasive Surgical Institute, Crown Valley Outpatient Surgical Center (Mission Viejo, Calif.): Rising costs of supplies and increased staffing costs (to keep staff who would otherwise be taking hospital jobs with higher pay rates) will ultimately make or break ASCs this year. We try to renegotiate our supply contracts, operate efficiently with scheduling cases and staff as well as only opening the supplies necessary for our cases. We are extremely fortunate that our surgeons, proceduralists and anesthesia providers are all on board with trying to save costs where we can.

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