Deb Yoder, vice president of facility development at Compass Surgical Partners, Wes Battiste, CEO and founder of Destin Surgery Center, Keith Hennegan, COO of AMSURG.Leaders across the ambulatory surgery center (ASC) industry agree on one point: ASCs have never been more essential to the nation’s health care ecosystem.
“I think as we see more acute care cases move into our world, we’re all getting really comfortable with the joints, the spine [cases], and now we’re moving into two, three level spines as the codes and and things change,” Deb Yoder, vice president of facility development at Compass Surgical Partners, told Ambulatory Surgery Center News at the Investment & Operations Conference.
“What I’m working on a lot right now is in the CV space,” Yoder added. “We have multiple cardiovascular ASCs being developed and designed.”
Compass Surgical Partners is an independent partner specializing in the development and management of ambulatory surgery centers through joint ventures with health systems and physicians, with over 250 ASCs developed in the past three decades.
Yoder’s team is also preparing for electrophysiology cases and more advanced cardiac interventions, all of which require specialized room designs and the right HVAC standards.
Broader coverage for procedures plays a key role in expanding ASC case mixes, Keith Hennegan, COO of AMSURG, told ASC News at the conference.
Tennessee-based AMSURG is an ASC management company with a network of more than 250 centers across the U.S.
In addition to the trend of taking on higher-acuity cases, the ASC industry is also being defined by a rise in partnership activity.
“There are more than 4,000 independent ASCs in the country, all of whom are going to continue to see pressure with regard to physician succession planning, as well as margin pressure,” Hennegan said.
On their end, health systems are at varied stages of embracing an ambulatory strategy. Some still need to view ASCs as valuable resources for getting patients the services they need as quickly and efficiently as possible.
“I’m amazed and shocked to some extent, when we go sit down with some of these health systems, and they have thousands upon thousands of patients who are in need of a colonoscopy, for example,” Hennegan said. “And we know today that there is a handful of them who have cancer, and that is sobering. It’s frustrating.”
Although some health systems are maturing in their approach, others are racing to catch up, driving more discussion around joint ventures and physician equity models, Hennagan added.
“They’re racing very quickly to try to establish a strategy,” he said.
Despite strong tailwinds, ASCs also face substantial headwinds, including staffing challenges, anesthesia coverage and complicated joint ventures.
Keith Hennegan, COO of AMSURG.
Staffing shortages
ASCs have not been immune to the industry-wide scarcity of nurses and other clinical support staff. Building a positive culture is paramount, Yoder said.
“We can hire some for skills, but we can never hire for culture,” she said.
Creating pipelines of talent, whether by supporting existing staff through nursing school or forming partnerships with local training programs, can also help ASC leadership, Wes Battiste, CEO and founder of Destin Surgery Center and an advisor with Avanza Healthcare, told ASC News at the conference.
Destin Surgery Center is a multi-speciality surgery center in Florida. Avanza Healthcare is a health care advisory firm.
Doing so can help ensure that ASCs have the dedicated professionals needed to keep pace with growing case volumes, Battiste said.
“So we take roles where OR techs, we get them to nursing school and they become nurses,” he said. “We created opportunities for student programs; we created a pipeline for students to then become employees.”
Anesthesia is a particular pain point for many centers. In some markets, half of ASCs must pay subsidies or income guarantees to secure providers, Battiste said.
“We are seeing [these subsidies] more and more,” he said.
Still, he uses a similar pipeline approach to combat some of these issues.
“We’ve done similar with anesthesia,” he said. “The anesthesia model is unique because now ASCs are in the business of paying stipends and income guarantees, which is new in the last several years. In the state of Florida, in a large market, 80 centers, over half, have a stipend or income guarantee in place.”
Health system partnerships and value-based care
Another complexity is handling the sometimes divergent priorities of national hospital executives versus local hospital or health system leadership, Yoder said.
“Frequently, the corporate entity, and the regional entity, don’t have a conversation with the local CEO at the hospital,” she said.
Health systems often need time to fully mature their ambulatory strategy, Hennegan said.
“One story we had was the overall system CFO was like, ‘This is great, we have to do this,’ and then the local CFO goes, ‘No, my total joints aren’t leaving the hospital. What are you doing?’ But there are health systems, again, that are maturing to the ideas of their physicians having equity, and I think that’s fueling a lot of the JV discussions, and it really is interesting to see how that varies among larger health systems and then smaller regional ones,” he said.
Along with JV partnerships, value-based care is growing slowly but steadily in the ASC arena, Hennagan added. AMSURG signed its first value-based contract last year, an arrangement that Hennegan said will become increasingly common as payers demand cost and quality metrics.
“This was something for us that started with just our foundation, which is great clinical care, and having a payer who was seeking to solve a particular problem,” Hennegan said. “That’s something we certainly hope to continue.”
Even so, billing and reimbursement remain thorny. Battiste cautioned that prior authorization and other administrative hurdles can delay patient care, especially if physicians aren’t fully committed to obtaining approvals. Moreover, while patients want predictable, transparent pricing, the complexity of payer contracts can complicate things.
“It really comes back to the physicians, because the physicians are always the ones obtaining the approvals,” he said. “Are they willing to go the extra mile, have the peer-to-peer review, are they willing to do that to get the case to the ASC?”
Patient education is also important in this realm, he added.
“Just educating patients to understand this process, because they’re the ones getting delayed for having a procedure due to medical necessity claims not being there,” he said.
And patients’ financial sophistication is growing, driving greater interest in cost comparisons.
“We’ve had patients who would call us, call the local critical access hospital, call the hospital to see how much we were charging for this procedure, because the physicians had privileges anywhere, and they’re getting smarter, and there’s more data out there,” Yoder said.
Operators can keep up with elevated demands by focusing on small but meaningful steps: such as investing in staff development, improving the patient experience and building strong surgeon relationships, Hennegan said.
“We can do no great things, only small things with great love,” he said, quoting Mother Teresa. “And the difference is going to be service.
Deb Yoder, vice president of facility development at Compass Surgical Partners.
