What ASCs leaders are nervous about 

Seven leaders joined Becker's to discuss what they're most nervous about right now. 

Deborah Herdman, RN. Administrator at Paragon Surgery Center (St. Thomas, U.S. Virgin Islands): What makes me nervous is that it seems to be very challenging to stay in compliance with all the required reporting. This additional work often comes with additional operational costs that require balancing against declining reimbursement.

Another issue that makes me nervous is the cost of new technology, which is needed in order to stay competitive. For example, one of the surgery centers that I worked with previously had a surgical robot. That costs over a million dollars, and that's the older model robot. For many physicians, it's unsatisfactory to use older technology.

Mahoua Ray, MD. Co-founder and Managing Director of Kansas Pain Management and Kansas Anesthesiology Professionals: The thing I'm really nervous about is the reimbursement cuts from Medicare. I'm also nervous about less young people going into healthcare; I feel like all the way from the front office to prior authorization, from nurses to LPN, that population is getting closer to retirement. I don't have as many younger people come in, so that makes me a little bit nervous about the future.

Brian Gantwerker, MD. Spine Neurosurgeon at the Craniospinal Center of Los Angeles: Probably the thing that makes me the most nervous is the obvious play insurance companies are making to essentially squeeze as much profit as possible out of medicine. There is an unwillingness within Congress to confront the largest driver of healthcare costs, which is the insurance company insurance premiums and Big Pharma, so they continue to go after physicians and physician reimbursement. The No Surprises Act, while it was a very good piece of legislation, has been asymmetrically applied to favor the insurance companies. I think what's really fearsome is that the bureaucracy within the Centers for Medicare just seems to be either tone-deaf or willfully ignorant of what's really driving the cost of care. That's really scary because over 110,000 physicians left the practice in 2021 — that should give pause to everybody, and I don't think you can grow physicians fast enough to really take up that gap. 

Rick Ngo, MD. Founder and General Surgeon at Texas Surgical Specialists (Fort Worth): I'm nervous about [value-based care] in that there may be a lot of physicians who are mainly about fee-for-service and volume may exit the profession. Maybe my own personal salary will take a hit, depending on how we derive these formulas. So it's important for physicians to be involved in the discussions on how they get reimbursed under the umbrella of value-based care. 

Choll Kim, MD, PhD. Founder of Minimally Invasive Spine Centers of Excellence (San Diego): I am nervous about the increasing influence of insurance companies and hospital administrators on the practice of medicine. Our interactions with these entities have always been somewhat adversarial, and as a physician, I feel less and less empowered in the relationship. I hope physicians can better cooperate to make our voices heard in this era of insurance provider consolidation and population explosion in administrative personnel. 

Philip Louie, MD. Medical Director of Research and Academics at the Center for Neurosciences and Spine at Virginia Mason Franciscan Health (Seattle): We are seeing major health systems post astronomical financial losses in 2022. Short staffing, burnout and hospital capacity are compounding the ongoing obstacles that we struggle with as we work toward reversing these mounting losses. With growing pressures to produce financial and volume targets with limited — and temporary — resources, there will be an enormous focus on producing quantity of work. I worry that all the work that we have accomplished in building value-based care pathways, developing quality-based programs and academic pursuits to innovate will take a back seat to providing the greatest volume of care to "catch up" and race toward short-term financial goals.

Jacqueline McLaughlin, RN. Administrator at Northwoods Surgery Center (Woodruff, Wis.): With the increased volume comes the need for increasing staffing and adding physicians. I am most nervous about covering staffing needs in the future or holding back growth due to lack of healthcare professionals that are available.

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