The big problem facing ASCs this year

The ASC industry experienced significant growth in the early 2000s with a large number of surgeons developing and investing in surgery centers.

Many of those surgeons have run successful businesses for the past two decades and now are considering retirement. But will there be enough new surgeons willing to take over?

"As the generation of independent surgeons that founded many ASCs 20 to 25 years ago approach retirement, there may be fewer surgeon investors available to replace them," Scott Thellman, MD, surgeon at Lawrence (Kan.) Plastic Surgery, told Becker's.

The number of independent physicians who could potentially invest in ASCs is shrinking. Around 70 percent of physicians in the U.S. are employed by hospitals or corporations, according to a 2021 Avalere report. During the first year of the pandemic, 48,400 physicians left independent practice for employment. Pandemic-related uncertainties, challenging payer policies and increasing expenses have led some surgeons to sell their centers to the hospital.

"I think the next three years will be pivotal for ASCs for multiple reasons in regard to aging surgeon owners. These surgeons see inconsistent payer practice from CMS and commercial with restrictive prior authorizations and then the removal of the 258 CPT codes from the ASC. It's so hard to decide where to go with this information. Do we invest in more, or do we retire?" said Christine Blackburn, BSN, administrator of South Kansas City SurgiCenter. "Additionally, COVID-19 and all of the variants and the expense and changes that come with this. If they are close to retirement, this might be the tipping point for the physician. Can the new surgeon afford to buy into a center?"

Early career physicians are also more likely to select hospital employment, attracted by high sign-on bonuses.

The cost of buying into a mature ASC can also be prohibitive because many early career surgeons carry significant medical school debt. Some ASCs are taking innovative measures to recruit and retain physicians, such as connecting them with resources to help them buy in.

Tina Piotrowski, CEO of Copper Ridge Surgery Center in Traverse City, Mich., said physician owners of her center have been recruiting recent graduates, who recognize the value of private practice.

"Some physicians that have been investors have realized [ASC investment] was a very wise thing for them to do, and they've been very encouraging for younger physician investors as well, despite having been through a pandemic where we had a percentage of our cases lost due to the elective surgery shutdown," she said. "They've been some of our biggest promoters in physician recruitment, and we've been excited to add more physician investors over the past six months."

Timothy Kremchek, MD, a surgeon with Beacon Orthopaedics & Sports Medicine in Cincinnati, is similarly optimistic.

"I think the physician shortage is going to swing to the advantage of the physician," he said. "With higher competition, many physicians are fighting for new business, especially 'good business.' This will allow better physician reimbursement — hence, higher motivation."

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