10 ASC leaders' thoughts that rocked 2023 

Here are 10 thoughts shared with Becker's by ASC leaders that give key insight into the industry:

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. 

Alyson Engle, MD. Pain Medicine Physician at Northwestern Medical Group (Chicago): Procedure reimbursements have failed to keep up with inflation and do not reflect the increased  work demands of physicians. Insurance company profits soar while physician salaries decline. Less physicians will be inclined to stay in the workforce as the economics do not make sense. This trend is unsustainable for our nation's health and will lead to lower quality care as physicians leave medicine. Many patients are forced to defer treatment, which can lead to higher direct and indirect healthcare costs for the entire country. Less profitable procedures will be cut out of service lines, which can also lead to worse health outcomes.

Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: We currently are no longer accepting Medicare Advantage. The restrictions regarding these plans have made taking care of patients extremely cumbersome. Even routine studies are denied. I had a patient I met when on call with an odontoid fracture. I fixed the fracture by fusing the first and second vertebrae together from the back. Her plan denied a follow-up CT scan, which is routine, at six months. The plan denied the scan because she "did not have a spinal cord injury."  We appealed because: 1) The whole reason I did the surgery was so she wouldn't get a spinal cord injury; and 2) The proper study for a spinal cord injury would very likely be an MRI, except in certain situations. Either way, the denial was ridiculous. If you couple that with payment issues — late or no payment all, along with increasingly uncovering the money-making scam MA plans have turned out to be — taking these plans becomes a losing option. I feel for the members and encourage them to talk to their insurance agents, or in some cases, their human resources people to seek other options. Many hospitals have also stopped taking them altogether. The unfortunate truth is that the companies offering these plans and TV commercials mislead patients into thinking they are doing the right thing. The patients lose by giving these for-profit companies their hard-won Medicare benefits while the companies don't pay anyone who is giving care. It's a scam whose end time has come. 

Marsha Haley, MD. Clinical Assistant Professor of Radiation Oncology at the University of Pittsburgh: Declining reimbursement is a huge issue that leads to many other problems. Physicians do not receive an inflationary reimbursement update — in fact, Medicare physician pay has declined over 20% over the past 10 years. With inflation resulting in rising overhead costs, it becomes more difficult for private practices to remain viable. These practices are then vulnerable to purchase by large, vertically integrated health systems. Physicians and their patients may then become victims of the corporate practice of medicine, which results in increased physician burnout and a decline in the quality of care.

Alex Portillo, RN, BSN. Administrator of Manhattan Surgery Center (New York City): My biggest concern is the pushback we're likely to receive from insurance companies continuing to underpay ASCs for procedures when compared to hospitals. As cases are being pushed out of the hospitals and into ASCs, I can see insurance companies counting the uptick in volume to a center as "getting more" reimbursement instead of narrowing the pay disparity between hospitals and ASCs for the same exact case. I'd like to see a more fair reimbursement as ASCs are becoming the standard of care for patients, but I'm sure that's way far off into the horizon.

Todd Neiss. Business Manager of Bismarck (N.D.) Surgical Associates:  Where ASCs are losing money right now is with payers not processing claims correctly. They deny claims that should be paid or have a third party process claims that don't even follow the payers' policies and guidelines and they deny claims that should be paid. You fight for these claims to get paid, and they require you to appeal and you find out that the appeal is being sent to the same third party processor, and they automatically deny, citing the exact same reason the claim was denied in the first place. They didn't even look at the supporting documents included with the appeal outlining why the claim should be paid. Then finally, you are able to submit a second level appeal, which is then reviewed by the payer and you get someone who reviews the information and our claim gets paid.

Harry Severance, MD. Adjunct Assistant Professor at Duke University School of Medicine (Durham, N.C.): How many bright young minds when facing an option of a decades long delay in earning potential while simultaneously accruing up to a half million-dollar debt, all while considering entry into an increasingly hostile and dangerous workplace of insane workloads and increasing liability and burnout, where the patients you sought this career in order to help are increasingly assaulting you, and where your management feels you are oppositional and a threat to their profits — now with the added insult of declining pay — would now even consider entering into such a career? Does this look like a smart career choice? Declining pay could be the final straw that, if not checked, will lead to increasingly fewer bright young minds choosing a career in healthcare and thus further accelerate the already critical shortage of physicians in this country.

Joseph Sewards, MD. Chair of Orthopedics and Sports Medicine at Temple University (Philadelphia): I think the recent exemption in the Stark law for health systems and hospitals to be able to provide mental health services to physicians is what I have my eye on. I don’t know of any hospital that was withholding those essential services for fear of violating Stark, but anything that removes any barriers to access mental health services for physicians is a huge step. There already are enough barriers out there, and physician burnout and other signs of deteriorating mental health/wellness is getting to be a problem that is quickly getting out of control.

Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: People wonder why our healthcare system is in such a turmoil. Poor access to doctors, and emergency rooms are so overcrowded with trivial problems. Who wants to go into medicine when your reimbursement goes down every year? I pay more for my plumber or electrician than I make per hour. Also, the restrictions are becoming unbearable. And don't forget the underlying fear of malpractice. Our healthcare system is a travesty, and I have to blame much of it on the government. Big business is running medicine and that's a shame.

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