5 things worrying ASC leaders

Twenty-five ASC leaders recently joined Becker's to discuss the trends they are monitoring in 2024. 

Here are five issues that are concerning them:

1. Anesthesia provider shortages

ASCs are feeling the pressure of increasing anesthesia provider shortages. Nearly 30% of anesthesiologists are predicted to leave the practice by 2033, leading to a shortage of 12,500 anesthesiologists, according to a white paper from Medicus Healthcare Solutions. 

The shortage is paired with an increase in costs of anesthesia.

"The cost of anesthesia services is a trend I am following closely," Ashley Hilliard, RN, administrator of Deerpath Ambulatory Surgery Center, told Becker's. "We are seeing more and more ASCs needing to offer stipends while still needing to maintain a healthy bottom line. The shortage of anesthesia providers coupled with the demand for higher wages is something to keep an eye on, especially in the smaller ASCs."

ASCs and hospitals around the country have had to postpone procedures because of a lack of access to anesthesia coverage. 

"The other major trend [I'm paying attention to] is the continued shortage of anesthesiologists, which has led to many surgery procedures having to be canceled and/or postponed both in the hospital as well as ASC setting," Bruce Feldman, administrator of Bronx (N.Y.) Ambulatory Surgery Center, told Becker's. 

2. Prior authorization

ASC leaders are also eyeing prior authorizations, which is affecting their ability to provide care — 34% of physicians reported that delays in processing a prior authorization led to a serious adverse event for a patient in their care, according to a survey from the American Medical Association. 

"Something must change on prior authorization reform; the current trajectory is not sustainable for the strongest of healthcare entities, let alone private practices with dwindling resources," Jacob Rodman, CEO of Raleigh (N.C.) Neurosurgical Clinic, told Becker's. "Regulators at both the state and federal levels must step up and do more." 

There have been some moves to reform prior authorization. In January, CMS finalized prior authorization reforms. Plans are now required to support electronic prior authorization processes by 2027, include the reasoning behind any prior authorization denials, and require all decisions to be made within 72 hours for urgent requests or seven days for standard requests.

Additionally, according to the AMA, 17 states have adopted comprehensive policy updates, and there are more than 70 bills of various types in more than 28 states being introduced this year. 

3. Physician workforce changes

ASCs are keeping a close eye on the growing migration of physicians to employed models. Around 108,700 physicians left private practice for employment from 2019 to 2021, according to a report from Avalere. As of January 2022, nearly 74 percent of physicians reported being employees. 

"This not only raises the cost of care but, in many markets, it eliminates competition," Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker's. "When there is no competition, patients have no choice for alternative care at different groups. Market consolidation through physician ownership is great for some parties, but in general losing all physicians to the PE firms, health insurance companies or hospitals is not good for the overall healthcare ecosystem."

Many leaders are also worried about its effect on patient care and physician autonomy. Nearly 60% of physicians said non-physician ownership of practices results in a lower quality of patient care, according to a survey from NORC at the University of Chicago. 

4. Technology shifts

Many ASC leaders are eyeing how technology is shifting the way physicians provide care and how patients approach their health. 

Artificial intelligence and machine learning, for example, can decrease obstacles in care provision. AI made waves in every industry in the last year, and while there are signs of physician apprehension toward AI adoption, many are stressing the importance of keeping up with changes. 

"For AI, there are already so many tools out there trying to solve real problems — with more on the way," Jonathan Davis, COO of Annapolis, Md.-based Clearway Pain Solutions, told Becker's. "It will be critical for us to stay aligned with these developments and to leverage them appropriately within our practice."

Patients are also looking to technology, and healthcare providers can use this to their advantage. 

"A significant innovation is already occurring with patients monitoring their health data at home in many ways," Samuel Jones, MD, a cardiologist at The Chattanooga (Tenn.) Heart Institute, told Becker's. "The medical team needs to find ways to utilize this data effectively for the patient's benefit. Issues such as reimbursement and patient privacy will be critical to clarify.

5. Supply chain issues

ASCs are still facing supply chain shortages and supply cost increases exacerbated by the COVID-19 pandemic.

"Costs continue to rise, and we still seem to be dealing with back orders and items not in stock," Ms. Hilliard told Becker's. "I fear this will continue to be an ongoing issue, and it is important centers have a good materials manager because it may take looking at multiple vendors to get the best pricing."

Supply costs make up a median 28 percent of an ASC's revenue, according to Avanza's "2022 Key ASC Benchmarks and Industry Figures" report, so leaders will continue to keep a close eye on these changes. 

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