Is the future bright or dark for independent ASCs?

ASCs have given surgeons and patients a safe environment for surgeries during the pandemic, but the centers suffered financially when case volumes were limited last spring.

Some centers still have not recovered case volume and are finding it difficult to thrive independently, while others have developed growth strategies. Opportunities for success vary by location, specialty and market-specific payer trends.

Here, 10 ASC owners and operators discuss whether the future is bright or dark for independent centers.

Lori Tamburo Martini, CASC. Administrator of SOG Surgery Center (Tupelo, Miss.): Having been an administrator for two independent ASCs, including my current facility, and one joint venture with a hospital partner, I have experienced the pros and cons to both structures. The future for independent ASCs really hinges on the market they are located in. In a rural market, independent ASCs can thrive. However, there are many hurdles, such as certificate of need laws and lack of leverage with payers. These challenges can be overcome, but aligning with the right contracted services for things like payer contracting, supply chain and marketing is key. Also, independent ASCs must do things to set themselves apart from their competition, like achieving additional certifications with their accrediting body and providing exceptional customer service.

Robert Lerma. Administrator of Blue Springs Surgery Center (Orange City, Fla.): The future is bright for independent ASCs. The three main reasons are:

1. An independent ASC can offer a surgeon greater opportunity for ownership, flexibility in scheduling and input into operations of the center by participating on center committees.

2. An independent ASC is governed by a board of physician owners and can provide direct and timely governance affecting center operations.

3. An independent ASC does not incur management nor purchasing fees, provided the center has a strong and experienced management team.

LuAnne Jordan. Administrator of Savannah (Ga.) F&A ASC: Today I would say dark! We are a single-speciality surgery center and just limited as to what procedures we can do. We need to recruit more physicians so we can increase our volume. The insurance companies find so many ways either to delay payment or not pay at all.

Shawn Menke. Administrator of Genstler Eye Center (Topeka, Kan.): The future for independent ASCs is bright because of the consumer paradigm shift in demand for procedures in the hospital to ASCs. Consumers nowadays have a better understanding of that. Independent ASCs have proven to be much more efficient and less costly than hospital settings. One thing to look out for in more rural areas, like where our ASC is located, is the trouble recruiting surgeons to the area, especially ophthalmologists. Surgeons are in high demand no matter what area of the United States you live in. ASCs like ours may have to think about diversifying the specialties that do surgery in the ASC to continue to survive long into the future.

Suzi Cunningham. Administrator of Advanced Ambulatory Surgery Center (Redlands, Calif.): I believe the future is bright for ASCs. We have proven to be a vital resource for patients and providers in many specialties. Our facility, in addition to hundreds of others, have been able to provide much-needed care to patients when hospitals weren't able. ASCs also allowed surgeons a safe place to perform surgeries when delaying care may not have been possible, and we are able to do this at substantial savings for overall care.

Matthew Ewasko. Administrator of Physicians Alliance Surgery Center (Cape Girardeau, Mo.): I think the future for ASCs as a whole is bright. We are continuing to see a push for procedures to be done in the ASC setting, and I don't see that slowing down at all. With the increased technology available to our industry, it is more and more common for procedures that were once thought to be hospital-only to be done in the ASC. These procedures are done just as safe and effective, and are financially beneficial for all parties. The patient benefits due to reduced costs and shorter stays, while the ASC benefits due to the increased reimbursement and efficiencies that the ASC can offer when compared to a hospital outpatient department.

Seth Silver, MD. Medical Director of Ambulatory Care Center (Vineland, N.J.): When I look to the future, we've made some adaptive changes within our facility. We have compressed rooms and optimized our staff. Although when I last calculated we were still down 30 percent of our normal workload, the trend is promising. There also seems to be a push on the insurance side to greater utilize outpatient surgery. Overall I think our future is bright due to the high quality care that is provided at ambulatory surgery centers. I firmly believe we just do certain things better than the hospital facility. If you have any questions, look to our patient satisfaction surveys, which are 99 percent positive. But I am also not sure if we can continue to stand alone and most likely will be affiliated with a large hospital system shortly.

Melissa Hermanson, MSN, RN, CASC. Administrator of Ambulatory Care Center (Vineland, N.J.): I am the eternal optimist and truly value the autonomy and flexibility of working in an independent center, so it hurts to admit that the future is dark for independent ASCs. The only way for independent centers to grow and thrive is to recruit new physicians. Unfortunately, our current healthcare infrastructure drives new doctors to hospitals and megagroups, many of which institute restrictive covenants limiting a surgeon's ability to practice at the local ASC — regardless of the advantages to both the patient and physician.

Increasing health insurance premiums, coupled with a reduction in employer-sponsored plans, has resulted in an increase in publicly funded cases. These procedures have lower reimbursement, especially in the ASC environment. Many independent centers have sought the protection that hospital partnerships can bring with better contracted rates and, potentially, increased case volume.

Tammy Stanfield, BSN, RN, CCRN. Administrator and Director of Nursing at North Pines Surgery Center (Conroe, Texas): Bright for us. Our surgeons are on the cutting edge and up to date on the newest minimally invasive procedures to treat pain management patients. Our recent additions or technologies we plan to add soon include the Stryker Spine Jack and Omnia Medical posterior sacroiliac joint fusion. We will continue to perform procedures with spinal cord and column stimulators; interspinous spacer implants; sacroiliac articular fusions; and intrathecal pump implants.

Mike Grant. Administrator of Surgery Center of Amarillo (Texas): I think the future is bright for well-run, high quality, patient-focused, independent ASCs. More specialty service lines are successfully moving to the ASC setting. ASCs represent a great opportunity to provide high quality healthcare at significantly reduced cost to patients and payers. I think the future is very bright.


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