Top issues for 25 ASC, physician practice executives

These 25 industry leaders explain the top trends they're currently following. The executives featured in this article are all speaking at Becker's 2024 ASC conferences. This includes our 21st Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference which is set for June 19-22 at the Swissotel in Chicago. This also includes our 30th Annual The Business and Operations of ASCs which is set for Oct. 30-Nov. 2 at the Hyatt Regency in Chicago.

If you would like to join either event as a speaker, contact Randi Haseman at

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.

Question: What are the top 2-3 trends you're following in healthcare right now?

Michael C. Boblitz. CEO of Tallahassee (Fla.) Orthopedic Clinic: As a career strategy officer, I closely monitor the constantly changing market forces and incorporate the trends into our Vision 2030 Strategic Plan we review and update every year at our two-day annual board retreat.

Three trends that I am currently watching include:

  • Hospital systems continue to face significant headwinds from payers and employers to aggressively shift elective patients into lower cost settings, such as spine and joint replacement cases into ASCs. These pressures are causing hospital systems to quickly reevaluate employed physician practices that have not directly covered costs for many years. I am seeing more hospital systems now seeking a partnership model with large private practices with the scale and staying power to still deliver the system’s desired value and objectives while removing the historical financial losses. I am receiving these calls and excited to support our hospital partners.
  • New co-purchaser models that sit between the employer and the payer with the aim to aggressively steer patients into lower-cost 'centers of excellence' are growing quickly and require a thoughtful strategy. These new co-arrangements offer beneficiaries with cash incentives and travel costs to utilize these narrow network centers, such as orthopedics, that are often out of market. TOC is blessed to have the strength and quality to be considered for these center of excellence models that includes our full range of ancillary services and ASCs. These new purchasers desire our soon-to-open Spine and Joint Ambulatory Surgery Center as it replicates the hospital environment with private recovery suites for extended stay patients which includes private bathrooms with 30-40% lower cost.
  • Medicare Advantage enrollment has soared in recent years and now has a larger number of beneficiaries than traditional Medicare. To no surprise the payers have aggressively pursued this market. These managed Medicare plans are being challenged through the Medicare Part C budget constraints to reduce costs. This forces these private Medicare plans to try and pass the financial pressures on to the providers and you are already seeing trends across the U.S. where providers are starting to go non-par with managed Medicare products. Only time will tell it seems.

Eric Schnapp. CEO of Resolve Pain Solutions (Atlanta): Across the healthcare industry, we see a growing recognition in the need for personalized and multimodal pain management. There is a difference in simply offering pain management procedures in an ASC versus specializing in tailoring a comprehensive pain management program to a patient utilizing a variety of interventions, physical therapy, cognitive and medication based on that patient's history, needs and outcomes. While ASCs or non-pain specific practices have sought to append pain management procedures to their repertoire, the reality is that it takes both a provider's and an organization's specialization in pain to have the tools and expertise to produce successful outcomes. Patients are recognizing the difference it creates in their care, and now seek out and stay with pain management specialists.

Another trend is that the administrative and management burden on individual practices and ASCs has ballooned in recent years, and we see high quality pain management providers and practices struggle to maintain excellent patient care when that work eats away at their limited resources. While some practices seek security and stability by joining with other practices within the pain specialty, the whole does not become greater than the sum of its parts. Instead, those practices that experienced tremendous growth are ones who partnered with organizations specializing in the operations and optimization of pain management, thereby bringing best practices and expertise that helped to maximize the practice and its providers.

Kevin Fleming, MBA, FACHE. Vice President of Orthopedic Institute at AdventHealth (Orlando, Fla.): As we enter 2024 and are preparing to face the second half of the decade, I am energized to see so much focus in healthcare on areas that I really think will bring value to patients and communities around the country.

Leading organizations are focusing on their people. Investing in the development and sustainability of the healthcare workforce is vital, and it’s encouraging to see so many health systems focusing inward through better engagement with their team members.
Organizations that are focused on growth are also focused on finding the right partners with which to grow. Finding the right partner – be it another health system, an industry vendor or a physician organization – that shares an aligned mission and similar values can create synergies that become a strategic advantage in the dynamic healthcare ecosystem. The most creative solutions in this space will be exciting to watch!

Tricia Wollam. Clinical Administrator of Alliance Surgery Center (Traverse City, Mich.): For 2024, the trends I am following are the continued rise of anesthesia provider cost as well as the decrease in reimbursement rates for anesthesia services. The shortage of surgical technicians and the impact it has on surgical services. A positive trend I continue to follow is the existing growth of ASCs. Patients are continuing to become engaged consumers on their healthcare options and the advantages ASCs offer.

Pete Bekas. Administrator of Fort Apache Surgery Center (Las Vegas): I am watching labor shortages, particularly in nursing and technicians. Organizations are focusing on flexible work arrangements and wellness initiatives to attract and retain skilled professionals. Meanwhile, reimbursement strategies are shifting towards value-based care models, incentivizing quality outcomes over volume. Yet most payers are still fee-for-service and continue to lower reimbursement rates.

Jacob A. Rodman. CEO of Raleigh (N.C.) Neurosurgical Clinic: The top trends I am following in healthcare right now are mainly focused on prior authorization reform and the continued movement of spine cases to the ASC setting. Something must change on prior authorization reform; the current trajectory is not sustainable for the strongest of healthcare entities, let alone private practices with dwindling resources. Regulators at both the state and federal levels must step up and do more. Additionally, spine surgeons should be able to perform more cases in the ASC setting. We have seen the cases be performed safely at a greatly reduced cost to payers and patients. I would love to see Medicare come out and encourage more of these cases to shift site of service.

Bruce Feldman, MS, CPPM. Administrator of Bronx (N.Y.) Ambulatory Surgery Center: The top trends we are seeing in healthcare right now is an increase in the types of surgical cases that are moving from the hospital setting to the ASC setting. This is most notable in the areas of spine and cardiovascular procedures. My concern however is that reimbursement for these procedures is not comparable.

The other major trend is the continued shortage of anesthesiologists which has led to many surgery procedures having to be canceled and/or postponed both in the hospital as well as ASC setting.

Mario Gössl, MD, PhD, FACC, FAHA. Interventional cardiologist of Minneapolis Heart Institute Foundation:

  • Fair and sustainable value based care contracting
  • Representation of MDs with years of frontline experience and administrative education in C-suites
  • Workforce management – recruit and retain generation Y and Z

Joseph R. O'Brien, MD, MPH. Medical director for minimally invasive orthopaedic spine surgery of Virginia Hospital Center (Arlington, Va.) and spine surgeon of OrthoBethesda (Md.): Private equity investment: It can help leverage a powerhouse practice into a regional powerhouse. It creates economies of scale and allows for better negotiations with hospitals, payers and ASCs.

ASC / outpatient minimally invasive surgical procedures: Co-ownership aligns physicians with the economic realities of healthcare. ASCs allow doctors to share in the profitability of the center and have a synergy that may note be present in a hospital setting.

Rick Ngo, MD, FACS. Founder and general surgeon of Texas Hernia & Surgical Specialists (Stafford, Texas):

  • The role of AI in healthcare
  • The growth of private equity in the ASC space

Anthony J. Tortolani, MD. Cardiac and thoracic surgeon and professor emeritus for clinical cardiothoracic surgery of Weill Cornell Medical College (New York, N.Y.): More than 66 million Medicare patients are enrolled in Medicare Advantage programs. This is to allow Medicare patients to access care in the private insurance market. Risk adjustment scores, upcoding utilization increase cost to Medicare, increase profits to Medicare Advantage programs. Will it increase quality or efficiency?

The etiology of ischemic heart disease (112 million people globally) can be obstructive epicardial or secondary to vascular dysfunction, micro or epicardial. Two thirds of patients with angina have no obstructive disease and can frequently be treated with medication. Obstructive disease, early in its course, may be treated medically. More, however, are treated early, prior to infarction, electively, with either PTCA or CABG; both demonstrating improved long term survival. Many of these diagnostic and therapeutic interventions may be done in an outpatient setting cardiac catheterization lab. This may be more efficient, less costly; conclusively define etiology, improve outcomes and prolong life.

Samuel O. Jones IV, MD, MPH, FACC. Cardiologist of The Chattanooga (Tenn.) Heart Institute: The impact of artificial intelligence. There will be pros and cons to this. We worry that it could dehumanize the patient-physician relationship, paradoxically increase administrative burden, lead to critical information overload and even provide inaccurate results. However, AI holds great promise for the hope it can streamline processes, provide greater access and improve patient care in many ways.

Transition of healthcare away from the traditional brick-and-mortar hospital system. Various procedures will continue to move to ASCs, as we have seen with orthopedics, gastroenterology and, increasingly, cardiology.
Increased disruption in healthcare. A significant innovation is already occurring with patients monitoring their health data at home in many ways. The medical team needs to find ways to utilize this data effectively for the patient's benefit. Issues such as reimbursement and patient privacy will be critical to clarify.

Alberto J. Villatoro. CFO of Clearway Pain Solutions (Annapolis, Md.):

  • Continue consolidation of practices nationwide and across specialties
  • Movement towards value based models
  • Decreases in reimbursement

Jonathan Davis. COO of Clearway Pain Solutions (Annapolis, Md.): For me, there are two trends that are top of mind right now and those trends are: 1) expanding beyond traditional physical healthcare to address the mental health needs of our patients and 2) finding the right place in our practice for the growing number of AI solutions.

The healthcare system is fragmented, and patients have complex needs that typically go beyond just one specialty. We are working to build a more integrated model of care to address these barriers and to provide good, complete patient care solutions. For AI, there are already so many tools out there trying to solve real problems – with more on the way. It will be critical for us to stay aligned with these developments and to leverage them appropriately within our practice.

Heather Smith. Director for invasive cardiology of Ascension (St. Louis): I am currently watching the trends of reimbursements in OBL, ASC and hospitals. The changing procedure mix allowable per CMS with the reduction of inpatient procedure list. I am mostly interested in how these two will collide to increase cardiovascular ASCs procedures. The third thing I have been interested in is right sided ablation use within cardiac ASCs and which private payers have approved ASC to perform these and under what circumstances.

Dean Lehmkuhler, MHA. Administrator of Northside Gastroenterology Endoscopy Center (Indianapolis): I am focused currently on hiring qualified staff for office roles such as insurance verification and authorizations, CRNA and anesthesia support, and real estate and construction costs.

Alejandro Badia, MD, FACS. Founder and chief medical officer of OrthoNow (Doral, Fla.): I am personally proud of my launching the biweekly podcast "Fixing Healthcare.. from the Trenches" which has particularly focused on positive trends to streamline healthcare delivery while decreasing costs, a very necessary initiative. The public engagement has been promising and the breadth of invited guests has been rewarding

I see several positive trends that I hope to further nurture if possible. First is the continued move to outpatient surgery care and the expansion of the 'permitted procedures' list which is ultimately good for patients, clinicians and our economy. I also feel the increased reimbursements to ASCs, while admittedly modest, will help shift the public focus away from the big hospitals, something desperately needed. Another trend is expansion of digital health where we can initially evaluate patients remotely and the ease of engagement then often leads to booking a needed procedure, benefiting the ASC ecosystem.

For 2024, I look forward to continuing the trend to move away from unnecessary pre-authorizations, and rather let clinicians make decisions unencumbered, but with necessary oversight of course. I also look forward to seeing a greater collaboration with outpatient walk-in centers which are convenient for patients, but can benefit from a close affiliation with an ASC so that the entire patient journey can occur in a streamlined, cost-effective ecosystem.

Johnny Russell. Director for area operations of Sutter Health (Stockton, Calif.): New and innovative ways to create more access for patients is always on trend. Inside Sutter’s surgery center division, we are prepping for orthopedic-spine procedures in selected ASCs to include anterior cervical discectomy with fusion, lumbar laminectomy and microdiscectomy. This service expansion will allow patients to have life-changing surgery in an outpatient setting while enjoying same-day discharges back home. This collaboration with hospitals allows for more opportunities to care for other patients with urgent and extended care needs. Greater access can also mean greater convenience. To better meet patients’ needs, our ASCs have extended their hours beyond normal business hours. Scheduling past 3 p.m. allows the physicians to care for more patients each day! We also offer Saturday appointments for GI and surgical patients, which helps them plan accordingly while not missing work.

Choll Kim, MD, PhD. Orthopedic spine surgeon of Excel Spine (San Diego, Calif.): The biggest, most relevant trend in 2024 will be the impact of social media on the way our patients learn about their conditions and the options for treatment. More and more physicians, healthcare systems and device manufacturers are relying heavily on social media video shorts to convey their message in brief, bite sized pieces in an engaging way. Those who look upon social media with disdain will be in for a harsh reality check. Imagine a world without email…

Ashley Hilliard, MBA, MSN, RN, CPAN. Administrator of Deerpath Ambulatory Surgery Center: The cost of anesthesia services is a trend I am following closely. We are seeing more and more ASCs needing to offer stipends while still needing to maintain a healthy bottom line. The shortage of anesthesia providers coupled with the demand for higher wages is something to keep an eye on, especially in the smaller ASCs.

A second trend is one we have seen for a while: the cost of supplies and supply chain issues. Costs continue to rise, and we still seem to be dealing backorders and items not in stock. I fear this will continue to be an ongoing issue, and it is important centers have a good materials manager because it may take looking at multiple vendors to get the best pricing.

Andrew H. Lovewell, MHA, MSHI, FACHE. CEO of Columbia Orthopaedic Group (Columbia, Mo.): The top two to three trends that I am following in healthcare right now are: the critical shortage of personnel in key areas, the vertical integration of payers and the lack of growth in the private practice space. Just like many others, our organization is dramatically impacted by shortages in key personnel. We are short in anesthesia personnel, key business office functions and surgical technicians. Our shortages compound as payers make the process significantly more complicated to get paid for services. Finding qualified anesthesia personnel that embrace the high volume orthopedic ASC is a challenge as well.

The other area that is of great concern to me is the vertical integration and market consolidations of the payers. The largest payers today are ten times the size of the largest health systems in the U.S. When the largest employer of physicians in the county is also the largest payer by market cap, we have a problem. Not only are the insurance companies employing physicians in large quantities, they own the software solutions some of us use, have ASC management companies and are slowly expanding their empires in other key areas.

The last thing that keeps me up at night is the continued exit of physicians from private practice to the employment world. This not only raises the cost of care but, in many markets, it eliminates competition. When there is no competition, patients have no choice for alternative care at different groups. Market consolidation through physician ownership is great for some parties but in general losing all physicians to the PE firms, health insurance companies or hospitals is not good for the overall healthcare ecosystem.

Janet L. Carlson, MSN, BSN, RN. Executive director for ambulatory surgery centers of Commonwealth Pain & Spine (Chapin, S.C.): The top three trends I am following in healthcare right now are the following.

The Outpatient Surgery Quality and Access Act H.R. 972/ S. 312 that would align reimbursement from CMS for ASCs to match that of HOPDs. Essentially this legislation would combine the HOPD and ASC case volumes to one payment calculated weight scalar. This will allow more Medicare cases to be shifted to the ASC site of service with proven quality outcomes and lower cost.

The certificate of need laws in specific states are a continued source of interest to me. They are being challenged in many states to allow for better market competition opportunities for independent and entrepreneurial surgeons who want to provide their patients with the best care possible for an affordable price in an accessible ASC location.

The FTC next steps for physician non-competes that are stifling the practice of medicine in America today. The restrictive covenants of existing non-compete agreements prohibits physicians from maintaining continuity of patient care in their home community.

James Chappuis, MD, FACS. Orthopedic spine surgeon, founder and CEO of Spine Center Atlanta: The top trends I see right now are an increase in AI usage and mergers. AI helps with streamlining administrative tasks and operational efficiency. We are experiencing a wave of mergers and acquisitions as organizations seek to expand services and save on cost efficiencies. These changes reflect a broader shift toward leveraging technology and strategic partnerships to drive innovation and improve healthcare.

Omar Khokhar, MD. Partner of Illinois GastroHealth (Bloomington, Ill.): We are becoming increasingly aware of how what we consume affects our physical and mental health. The gut microbiome, long misunderstood and considered the 'final frontier,' is now a prime area for diagnostics and therapeutics. What's most interesting is how what we eat can affect our microbiome and, in particular, the velocity of change in our gut microbial composition which may occur in a matter of hours! Recent data suggests improvements in sleep, mood, appetite and mental clarity based on gut microbiome health.

Another trend of concern is recruitment to underserved areas with new physicians choosing to stay in urban centers. Coupled with COVID-induced retirements, this is causing major shortages in areas outside of metropolitan centers.

Ali Ghalayini. ASC administrator of Munster (Ind.) Surgery Center: As an administrator for an ASC specializing in pain management, I closely monitor several critical trends within the healthcare sector that have significant implications for our operations and strategic direction. Here are the top two trends that are particularly pertinent to our focus area:

1. Shift towards outpatient care and ASCs: There's an accelerating trend of procedures shifting from hospital settings to outpatient facilities like ASCs. This shift is driven by advancements in minimally invasive surgical technologies, allowing safer procedures with faster recovery times. It is also motivated by cost savings for both healthcare providers and patients. This trend is particularly relevant for our center as it underscores the growing demand for ambulatory surgery services, presenting opportunities for expansion and specialization in pain management procedures.

2. Integration of telehealth and remote patient monitoring: The adoption of telehealth has surged, a trend significantly accelerated by the COVID-19 pandemic. For ASCs, integrating telehealth services offers many benefits, including pre-operative assessments and post-operative follow-ups, which can enhance patient convenience and satisfaction while optimizing staff efficiency. Additionally, remote patient monitoring technologies are becoming increasingly sophisticated, enabling better post-procedure care and pain management for our patients at home. Keeping abreast of these technologies is crucial for improving patient outcomes and operational efficiency.

Devi Nampiaparampil, MD, MS. President and CEO of Metropolis Pain Medicine (New York, N.Y.): I am following trends with the workforce. Which days do people work at the office vs. from their homes? What times do they typically wake up and get started in the morning i.e. when do we start getting phone calls and emails? I am trying to adapt the practice to the needs of our patients. That way, we can improve patient satisfaction while lowering our costs at certain times.

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