Managing physicians and care teams can require ASC leaders to navigate difficult conversations around everything from OR efficiency to the cost of care.
Two ASC leaders recently joined Becker’s to share the conversations they find themselves having repeatedly — and the strategies that have helped make them more productive.
Question: When it comes to managing physicians or other providers at your ASC, what’s the hardest conversation you find yourself having again and again — and what has worked to make it less difficult?
Rao Saladi, MD. Administrator and CEO of Atlantic Surgery Center (West Islip, N.Y.): For ASC administrators and surgical directors, some of the most difficult recurring conversations involve scheduling and block-time utilization. Reducing or revoking block time for high-volume or founding physicians can be particularly challenging when their case volume declines. Similarly, addressing chronic lateness or lengthy preoperative discussions with certain surgeons can have a ripple effect throughout the day, resulting in delays, increased overtime, and disruption to overall OR efficiency.
Another challenging conversation involves asking surgeons to consider replacing costly proprietary implants or surgical tools with clinically equivalent, more cost-effective alternatives, particularly when the ASC operates under capitated or bundled payment arrangements. While these discussions can be uncomfortable, addressing them early can prevent operational and financial problems from compounding.
One strategy that has made these conversations significantly more objective is establishing a board-approved block-time utilization policy. Clear standards for utilization, scheduling, and block-release timelines provide a consistent framework for decision-making. This allows unused OR time to be reassigned appropriately without making the discussion feel personal or physician specific.
Ultimately, communication and data are key. Surgeons are often highly analytical, competitive, and business-minded. Walking them through actual case-costing data — such as demonstrating how a high-cost implant affects the margin on a specific procedure or how an unreleased OR block contributes to nursing overtime — can shift the conversation from a personal critique to a shared operational and financial challenge that the surgeon and ASC leadership can address together.
Finally, timing matters. Raising these issues early, using objective data, and approaching the conversation collaboratively significantly increases the likelihood of a positive outcome. The goal is not simply to correct a problem, but to establish clear expectations and create sustainable solutions that benefit the physician, the ASC, and ultimately the patients we serve.
Bradley Schmidt. CEO of Northern California PET Imaging Center (Sacramento): For conversations, the one I comment on nearly every day, is the need to position care through the patient’s and employer’s cost-sharing lens, particularly around care-cost burdens and transparency. Currently, care teams are generally excluded from pricing conversations. It is like being handed a restaurant menu with no prices.
There may be several clinically appropriate ways to complete a patient’s care, but we need more cost conversations at the point of care and discharge to make sure we are not unintentionally overburdening patients financially. The goal long term is to bring care teams back into the cost conversation — away from insurance or UM teams — as cost and innovation go hand in hand.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
