Industry leaders say that some of the most widely held beliefs in ASC management may be actively doing harm, rather than just being outdated.
From the push to move every case out of the hospital to the assumption that more volume always means more profit, these are the pieces of conventional wisdom three administrators and physicians told Becker’s they’d throw out first.
Editor’s note: Responses have been edited lightly for clarity and length.
Question: What’s a widely held belief in ASC management that you think is just wrong?
Bruce Feldman. Former Administrator of Eastern Orange Ambulatory Surgery Center and Current Founder of an ASC Consulting Firm (Cornwall, N.Y.): The idea that all cases can be done in an ASC isn’t accurate. What we’re seeing today is hospitals pushing more and more cases that were traditionally performed in the hospital into the ASC setting — largely to free up their ORs. But an ASC isn’t necessarily in the best interests of every patient. There are certain patients who, for various reasons — whether it’s comorbidities, age or the nature of the procedure — are more appropriate for a hospital setting. That envelope is being pushed in today’s healthcare environment. We’re seeing higher-acuity cases moving into ASCs, and most ASCs simply aren’t prepared to handle that level of complexity.
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia Consultants (Los Angeles): A common misconception is that anesthesia is the main constraint on ASC growth. In many cases, the issue is actually operational alignment. Unpredictable schedules, underutilized block time and last-minute case changes make staffing appear limited when the real problem is variability in demand. Another misconception is that anesthesia groups can simply absorb downtime between cases. That worked years ago under a per-case payment model, but it is increasingly unrealistic in today’s workforce environment. Centers that recognize anesthesia coverage as core operational infrastructure tend to perform better.
Bonnie Greenblatt. Director of Ambulatory Surgical Services of Michigan Institute of Urology (Utica): The adage of “volume solves everything.” With the wrong case mix, volume can actually be detrimental. Lower-margin cases can actually increase losses. Payer mix and contract negotiation play a major role in a financially successful ASC. Additionally, supply costs must be managed and reviewed routinely. Expensive implants can be the kiss of death if you are not vigilant in reviewing costs versus reimbursement. Increasing staff costs, due to increased volume must be reviewed and analyzed. If adding staff to accommodate increased volume is not monitored closely, you can eliminate any positive cash flow very quickly with the additional staff costs. The best ASCs focus on the right cases, not just more cases. They optimize for commercial payer mix, high-efficiency procedures, surgeon block utilization and cases with the best margin.
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