ASCs' biggest challenges & how execs are solving them

From staffing shortages to supply chain obstacles, 17 ASC leaders joined Becker's to discuss what their biggest day-to-day challenges are and how they're solving them. 

Editor's note: These answers were edited lightly for clarity and brevity. 

DJ Hill. CEO of Compass Surgical Partners (Raleigh, N.C.): We have two. For our operational ASCs, staffing continues to be our biggest challenge. The recent pandemic put a significant toll on healthcare workers that is still materially affecting our businesses.    We’ve taken proactive steps to recruit more creatively and be much more aggressive in retention efforts, including compensation, total rewards and work experience. For our centers under construction, we are tightly managing our supply chain to ensure we can open on time and on budget. The most challenging items have been securing generators in a timely manner, so we’ve creatively attacked that problem. Right now, all of our projects are on schedule, but it’s taking significant more internal management time to keep them on track.

Alan Rimbo. Administrator of Lawrence (Kan.) Plastic Surgery: We work in a fast-paced yet complicated environment, so new obstacles arise daily. However, staffing remains a consistent concern and challenge within the healthcare landscape, and we are no different. Staff are in short supply in a demanding market, so they are constantly shifting positions. Our goal is to demonstrate a team-friendly and caring environment. Leaders often find themselves with blinders on and get focused on what’s in front of them, while losing sight of what’s on either side. We are making an effort to see what’s on our periphery. So we are in the process of creating a communication-centric, team-oriented, positive, upbeat environment for our staff. Our leadership team feels that it’s very important to make staff feel like they are part of our growth strategy. Which in fact, they may be the most important part, but often feel left out due to lack of communication. 

Chris Wetzel, RN. CEO of Surgery Center of Hamilton (Hamilton Township, N.J.): I am very fortunate to have a fantastic, committed team. This has enabled my facility to handle all the challenges that present to us daily. The No. 1 obstacle we face is related to the supply chain. We have always been proactive in managing our supplies. However, the continual onslaught of difficulty obtaining random but necessary items for patient care is a grind. I clearly understand supply and demand, but the multiples that some suppliers are charging on top of the regular cost is appalling. I am very fortunate to have a fantastic materials manager that communicates daily with my management team so that we can leverage our collective knowledge to tackle any issue that arises. We have also had a long history of increasing our inventory for critical items to ensure that we can provide the highest level of care. We have been practicing this policy many years before COVID-19. 

Scott Thellman, MD. Surgeon at Lawrence (Kan.) Plastic Surgery: The providers. As more surgeons recognize that ASCs are more efficient and easy places to work, they move their patients to those settings over a hospital-based facility. Patients prefer the convenience and lower out-of-pocket costs typically seen at an ASC.

Catherine Llavanes. CEO of Sante Health Partners (Los Angeles): There's been a huge shift in staffing and supply allocation shortages. After almost two years of the COVID-19 pandemic and with the vaccination mandates, organizations laid off many healthcare workers, which added to the twist. Day-to-day operations have not been easy, but finding ways to stay ahead is the key. We offer flexible time for those workers who are able to cover shifts during flex time, convert part-time and per diem employees to full-time, and negotiate longer shifts for the able and available staff, which has allowed us to schedule block times according to our staffing availability. Working with our surgeons on how to manage our block times has been the key to flex work time, even opening weekend block times if that helps our availability pool. We are also constantly onboarding per diem staff to add to our ongoing list to ensure options are available to help with last-minute sick calls and vacation coverage. And supply allocations have also been added to the mix of the pandemic pain. We have increased our budget reserve for essential supplies instead of buying when needed. This will help ensure that there will be minimal disruption if there is a supply shortage. We try to be prepared and stay in tune with the daily changes in emergency management in each state we operate. 

Andrew Wade. CEO of OrthoSC (Myrtle Beach, S.C.): Staffing is by far the biggest challenge that we're facing today. The inflationary market pressure on all of our collective purchasing power and the "great reshuffling" have created extreme wage competition and a hyper-competitiveness within the market. We’re addressing these challenges by raising wages/benefits, looking for ways to create increased flexibility in where, when and how our team members do their jobs, and working harder than ever to ensure that our team members know that we appreciate and value their vital part in our collective ability to take care of our community.

Brenda Carter. Administrator of Wilmington (N.C.) SurgCare: There are two big hurdles. The first hurdle that we face is staffing. We are having to compete with the hospital in wages. ASCs offer great working environments without the nights, weekends and call shifts, allowing for a better work/life balance, but wages are still a big driver in the market. The other big hurdle is declining reimbursements with skyrocketing costs. The overly inflated prices due to supply chain shortages and aggressive wages makes the need for careful materials management essential in these slim margins. The challenges we face are real and considerable, but remembering that ultimately it is about the patients makes all of the decisions we face worthwhile. We really do want the very best for each and every one in our care.

Benita Tapia, RN. Administrator of 90210 Surgery Medical Center (Beverly Hills, Calif.): Staffing has become a big obstacle for us right now. We have seen staff leave the healthcare industry during the COVID-19 pandemic. We also have staff suddenly have to be out because they got ill from COVID-19. Hiring nurses has become difficult due to a shortage. The cost for hiring nurses has gone up, and we are trying to compete with hospitals offering large sign-on bonuses. We are offering flexible shifts, early shifts, later shifts, part-time, full-time and per diem shifts. We are also offering quarterly bonus pay and weekends off to entice nurses to join us. 

Erika Wilcox, RN. CEO of Surgery Center of Boerne (Texas): Staffing. recruiting and retaining seem to be such difficult obstacles. ASCs can't compete with hospital bonuses, high pay rates and other hiring tactics. ASCs rely on nonmonetary compensation to attract staff to the setting. The difficulty comes in trying to grow the ASC's business and be able to support the growth with clinical staff. 

Ann Cook, RN. Director of nursing at Best Surgery and Therapies (Cincinnati): The biggest obstacle I face in my day-to-day is staffing. It is no secret that we are facing a nursing crisis, which is forecast to only get worse. It is a known fact that ASCs pay less than hospitals, the main reason being ASCs reimbursement rates are notoriously and appallingly lower than hospital reimbursement rates. However, employees fall in love with the work/life balance ASCs can provide (no call, no weekends, no holidays to work). Employee recruitment, retainment and engagement should be at the top of the list of every ASC leader's agenda. 

Bill Lindsey. CEO of OrthoGeorgia (Macon): Attempting to maintain adequate staffing levels.  With the increase in total joints, 23-hour stays, along with the physician add-ons (i.e., hand cases, etc.) and requests for flip rooms.

Laura Galeazzi. Administrator of Antelope Valley Surgical Institute (Lancaster, Calif.): Our biggest obstacle is anesthesia coverage. Since the COVID-19 pandemic, many healthcare providers, e.g. anesthesia providers and registered nurses, have opted to have more control of their schedules and income and have moved to practicing as locum providers. Some surgery centers are having to pay a stipend above anesthesia billing in order to secure coverage. This practice of paying stipends to secure medical staff could have detrimental effects over a prolonged period on some surgery centers.  

Debbie Smith. Administrator of Heart of Texas Surgery Center (Woodway): Our biggest obstacle is the limited ASC-approved codes for services that are eligible to be performed in an ASC.  We have proven with our hospital-without-walls designation that we are capable of doing hospital outpatient department procedures safely and more cost-effectively.

Brandon Thompson, RN. Administrator of CarePlex Orthopaedic ASC (Hampton, Va.): Currently, our biggest obstacle continues to be returning back to our sole-source contracts for supplies. We are still having to do a lot of shopping around to make sure that we have all the supplies we need, which is not allowing us to buy at discounted pricing. Currently, our team performs what we call the "Pepsi challenge'' where they are finding an item and shopping around to all vendors to find the best pricing. Once supply lines indicate a more consistent return to normalcy, then we will begin creating another sole-source contract. 

Kathleen Hickman, RN. Administrator of Dutchess Ambulatory Surgical Center (Poughkeepsie, N.Y.): Our biggest obstacles are staffing and supply chain. Our inability to meet the salaries of the local hospitals puts ASCs at a disadvantage for attracting clinical staff. Also, supplies are inherently on "back order," which presents issues of keeping inventory low enough to be cost-effective but not running out of supplies when orders are not arriving in the expected time frame.

Allison Stock, BSN, RN. Administrator of Lenox Surgery Center (Lenox Township, Mich.): So many challenges have hit the ASC in the past couple of years. Reimbursement is a huge issue that ASCs keep facing. As we see the push for single-payer healthcare, it's getting harder and harder to negotiate good rates with insurance companies. It is extremely important to be aware of what your payer contracts are, and if they are covering your costs of procedures in your ASC. The never-ending shortage of drugs and supplies is a huge problem that all ASCs are facing. It is taking creativity and collaboration to get through this difficult time. You must think outside of the box to find alternatives to items that have become staples in your ASC. Having good relationships with your vendors and other ASCs and health systems in your area to share and acquire items is essential.

David Horace. Administrator and owner of Bel-Clair Surgical Center (Belleville, Ill.): Controlling costs is the biggest challenge. Changing vendors on a constant basis to avoid being taken advantage of by vendors who have used this opportunity to increase their margins. When reimbursement is fixed it is a "zero-sum" game — either I make a margin or else my supplier who raised prices takes my margin. A classic of manage or be managed.

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