What ASCs Are Worried About As 2023 Ends

Erik Sunset: [00:00:00] Hey folks. And welcome back. I’m Erik Sunset. You’re host of the DocBuddy journal. This is episode 46 and it is our last episode of 2023. We’re going to be spending next week to relax and recharge and be prepared to hit the ground running in 2024 with a very exciting slate of guests that are going to be joining the DocBuddy journal.

We had a great run of guests in the the lead up to this episode too. So if you haven’t heard from folks like Dr. Amanda breezeway or David Howerton listen to this episode and then go back to the well if you have any holiday travel, what better time to catch up on the dock buddy journal.

If you’re on a plane or in an airport or in the car? So with that said, Got a solo show for you today. And we are going to be looking at a relatively new, very new. Piece of reporting from Becker’s healthcare around what AFCs are worried about as 2023 comes to a close. Now over the course of the last few months, while the guests that we’ve had on the dock buddy journal, [00:01:00] we’ve asked that question in closing to them. What is it that ASC should be planning for to end the 2023 on a high note and start 20, 24 off on the right foot. So I’m excited to compare and contrast answers here with the the folks that Becker’s spoke with.

There’s a couple of recurrent themes, so let’s get. Get into it. In no particular order here, we’re going to kick off with concerns around anesthesia availability, starting with a response from DJ hill DJs, the CEO of compass surgical partners out of Raleigh. They see anesthesia as a concern that has existed all year and will continue to exist as a concern in 2020 for the ASC industry, we’ll need to find new and creative ways to deal with the shortage as well as work with payers to address it as a collective.

Additionally, DJ also sees inflationary trends and supplies services, and staffing is a concern. But notes that they have been happy that their team has responded with innovative solutions. [00:02:00] Keep that thought in mind, we’re going to come back to innovative solutions. And then also on the anesthesia front as a concern for 2023 is Dr.

Larry Bouse. MD. He is the medical director at the surgery center of Kalamazoo, Michigan. And to quote. As an anesthesiologist and a medical director of an ASC, I’m acutely aware of the issues related to the shortage of anesthesia coverage. The anesthesia workforce supply issues have not spared the ASC world at RASC.

We are concerned about meeting our caseload needs between now and the end of the year with the anesthesia coverage that is available to us. Obviously December is generally a very busy month for elective surgeries. And yeah, and it’s anesthesia is a real problem and it’s been a problem for a number of years now. And a problem in the sense of not having enough in the CCR. Ologists or CRNs to be able to successfully, and that’s the Ty’s patients for their scheduled procedure. [00:03:00] Now, one of the things that’s interesting.

And we highlighted this in a prior episode of the doc bunny journal. As that there are a number of states who are doing everything they can to ease the shortage of doctor anesthesiologists, that, that There just aren’t enough of, and they’re expanding the rights to practice to those. CRNs and nurse anesthetists to be able to delivering the seizure as needed. Now that’s a prudent step, obviously. But the factor means that there is an outright shortage of both anesthesiologists and CRNs and that problem looks the persist. Into the future.

Now we’ve talked about this recently as well on the show that. What do you do to solve for an outright lack of physicians in general or anesthesiologists? And CRNs specifically. Well, one of those. One of the ways that you need to address this issue is by keeping folks in practice [00:04:00] longer. Keep them from retiring earlier. Then sort of their scheduled or anticipation anticipated retirement dates. But then how do you grow the pipeline of folks that want to be anesthesiologists or CRNs, that’s the trickier question there, because no matter how much work, ASTs as a collective do to address the shortage with payers as DJ hill pointed out. If you just don’t have enough workforce, you just don’t have enough workforce.

So that’s a real problem. It’s something to keep an eye on. As this cataclysm unfolds in slow motion in front of us, that we just don’t have enough people that want to be doctors anymore.

And unfortunately that’s a problem where there isn’t an easy button type of solution, right? Like there needs to be a, a. Macro economic and sort of a macro workforce. Lens that you’re looking through to solve for this. This. And like Dr. Boss pointed out that December is a very busy time of year for ASC is Dr.

IRA [00:05:00] Rickerman MD orthopedic surgeon at ortho United spectrum in Canton, Ohio shares that as we entered December, ASTs are always forced to navigate a very difficult balance of surgeon availability. ASC operating room capacity and anesthesia coverage. With the parent patient’s desire to maximize health care benefits prior to restarting. A new year’s deductible.

So again, the things that are spooking, the folks that are applied to Becker’s here. Are really around workforce availability. It’s the holidays. Not everybody wants to be working like they normally do the rest of the year. So surgeon availability operator and capacity and anesthesia coverage, which we’ve already discussed. To help people take advantage of their end of year benefits. It’s tough.

It’s really tough. Out there. And with this glut of procedures that happen at the end of the year, I hear from surgery centers that they are lacking in staff like surgical tax. So they have a full [00:06:00] schedule. They don’t have the necessary coverage in a surgical tech capacity, so where they have to do. They have to move the schedule around.

They have to cancel procedures and there’s nothing worse for an ASC than canceling your procedure. Where you have all of your ducks in a row, you just don’t have the necessary workforce to do the procedure. So what do you do? Well, hang on to that thought as well. Along with innovative solutions because we’re still not really hitting on what our guests have shared for what AFCs need to do to close out 20, 23 strong. And get 20, 24 off on the right foot. Foot. Next from John CFO of eye associates in Tucson, Arizona. The never ending problem, never ending story of AR. Here’s this quote, this is really a perennial issue, accounts receivable, more and more pairs, make it difficult to collect legitimate claims, stonewalling system errors, prior authorization, complications, et cetera.

We have a [00:07:00] lot of money tied up in accounts receivable that legitimately should be in our bank account.

That really is a tale as old as time, right there. I’m flashing back to my days in the pure revenue cycle management space. This is the direction payers have been going for some time. Stonewalling. System errors, you know, that would depend on what kind of system error we’re talking about. But prior authorization, complications and so forth in the stonewalling, you have to be prepared to work denials on. I’m on claims that should be clean, that are clean coming out of your system, going through EDI and then hitting the payer. You know, you catch in denial on one of those. Queen claims it shouldn’t be. You waste time on the phone. And then eventually you do get that claim paid, but it’s just every hurdle that can be thrown at you is thrown at you.

Do you have the gumption to work through, through those speed bumps? Sometimes. Yes. Sometimes now. And then the prior authorization complications. [00:08:00] That’s painful. If you’ve got your ducks in a row there to catch a denial for something like prior auth, when everything appears to be in order. But what are you doing when you’re relying on manual processes? What are you doing when you have post-it notes, stickered all around your computer monitor for your, for somebody in your revenue cycle team. You know, there, there is a better way there.

So hopefully those are self-inflicted prior auth issues that John Critcher is relaying and talking. About. Changing gears over the staffing and increased prices, I guess, changing gears back to staffing, but a new gear and increased prices from Julie Baker, RN admin of the Andover Massachusetts surgery center. The biggest concern for us is staffing and increased pricing on medical supplies.

We’re getting into our busy season season, or everyone wants to finish surgery before January 1st, making sure we have enough hands is that blowing our budget is a hard line to toe along with the increase in raw [00:09:00] materials price that makes up most of the medical supplies available. We have to make sure we’re constantly looking at what we did last year. Versus this year, that overspending in areas that have increased.

what. A fortunate position. Julie is in that they are able to blow budget on staffing. And what I mean by that is that everybody in every market has the luxury of being able to hire on demand. And we we’ve talked about it before classic healthcare fix, just go hire somebody and that will help our bandwidth and throughput issues. But for most of the country, and certainly don’t want to put words in Julie’s mouth that she can have.

She has access to essentially on demand labor. But for most of the country, that reality has long since gone. And, you know, in the run up to COVID through COVID and then now out the other side, knock on wood. The ability to just simply make a hire, get a warm body in here to help. It just doesn’t exist [00:10:00] anymore. And then with medical supplies and the increase in the price of the supplies and implants and so forth. I really like that she is tracking and trending. This year versus the previous year, to be sure that she’s not overspending in areas that have increased. For our ortho groups out there.

We’ve got a really interesting episode with Tim, the CEO advantage and go back through the catalog. He’s got a solution for you there. To be sure that you’re not overpaying for your supplies. Plies.

And now the last respondents to the Becker’s survey here, Shawna Alfano, MSN and RN. She’s the administrator and director of nursing. A bass surgery center out there in Walnut Creek, California. Shout out to my west coast listeners out there. As we near the end of the year, I’m not necessarily thinking of things that impact the now, but more of the future. By this she’s referring to, for example, what potential changes payers are making as we speak. That [00:11:00] will impact the bottom line of consumers.

I E our patient population that will directly impact whether these folks have surgery. Or not. We’ll policy premiums, deductibles, and co-insurance amounts. Finally reach a point where patients simply have to choose between a fracture repair and the cost of daily living. If, so how will this impact our already hammered healthcare workforce and the viability of ASC?

that’s a pretty heavy response. And I only mean that she, Shawna here is looking through the implications and cutting through a lot of the clutter. The cost of healthcare is not coming down anytime soon. So when she’s calling at that, will patients choose to fix a broken bone or are they going to pick, to buy groceries and gas? That’s a scary reality, a scary reality that many. You know, are dealing with day to day now.

And then she goes on to ask, how is this going to impact our hammered healthcare [00:12:00] workforce? We talked about at length and the viability of AFCs. When you look at the ASC as sort of the ideal setting. For straightforward procedures and even as more and more come off, that inpatient only list you’re already talking about the ideal alignment, whereas ideal as you can get between the patient. The provider slash facility. And the payer.

So we’re, Shauna’s raising this really valid concern where you’re getting low cost and high quality and effective care. The ASC. Versus the. Inflated price of the same procedure at a hospital. You know, she is got some really good foresight here, wondering what’s going to happen as the price of healthcare goes up and our venue of care in our facility, the ASC, which is already very cost-effective as cost-effective, as you can get.

Gotta be thankful for groups like ASCA, gotta be thankful for groups that are your state ASC [00:13:00] associations advocating for you and ensuring that this reality is minimized. That folks aren’t choosing or having to make the choice between. A broken bone fracture, repair, and paying for groceries. That takes a lot of lobbying. It’s going to take some legislative health. Help rather. BuT Shauna great call out there with. We’d love to get you on the pod.

And, and here’s more of your perspective on this.

So as we’ve gone through these responses from the the folks that Becker’s was able to get responses from. Compiling these and sort of neat and tidy little buckets. The availability of anesthesia. Everybody’s talking about that surgeon availability to end the year. Being able to reduce AR. And staffing and increased prices and the effect of. Patients as healthcare consumers needing to make a choice between their. Daily costs [00:14:00] or day-to-day costs and being able to receive care. aNd then contract and rate changes as well. All of these things are very tactical. They’re very frontline focused.

Obviously the question asked what our ASC is worried about is 2323 comes to a close. You know, it’s just a couple of weeks left when this was published, you know, there necessarily. Tactical concerns and their concerns that all of healthcare faces really, especially that, Hey, art piece that that’s essentially universal.

But to go a little bit more macro and look at this through a more strategic lens and obviously highly effective leaders are able to balance the two, right tactical.

What has to happen today? What do I need to do today to be successful? No matter what that is, whether you’re working at a healthcare facility. Or you are a cog in the machine of a business. You know, looking at tactics, what has to happen now versus strategy about a little broader view. What changes can I put in place so that my tactics [00:15:00] then change strategic versus tactical?

Right? When we’ve asked our guests over the last few months about what ASC need to be thinking about. To close out this year. And then looking ahead to next. One of the recurring themes. And I guess it’s not so much a recurring theme as a universal response was more strategic. But our guests. And even myself, we’ve advocated that AFCs and healthcare organizations be looking at the technology they’re either using or could and should be using. Now, obviously go back and listen to these episodes for yourself to get it straight from the horse’s mouth. But the reason the technology is such a common response and really the most popular response. It’s not because technology will fix every problem at your ASC. Or at your practice or at your hospital? But it’s because technology can deliver efficiency gains so that you can do more with less. The less may not be something you really want, [00:16:00] like a lack of anesthesiologists or unavailable surgeons, obviously you’d rather have those fully staffed. On the shelf ready to use when you need it.

But the right technology can certainly help you to identify the most profitable cases so that then can those be prioritized over? Less profitable cases. Obviously, that’s pretty cold hearted. We’re looking at medicine as a business. We’re looking at medicine as a production line in a factory. If you’re talking only about profits and not about patient outcomes. So we’re not, we don’t want to lose sight of that.

We don’t want to be callous. We don’t want to appear heartless here. But ultimately healthcare organizations are businesses. And when we’re talking about the ASC here in this podcast episode, an ambulatory surgery center is absolutely a business. And when you look at this. List of concerns. Closing out 2023. That [00:17:00] classic healthcare fix of just hiring employees. That isn’t possible anymore.

Making hires is really hard, no matter where you’re located. So why then would you as that business? Despite the fact that your healthcare facility, that you have providers, do you have patients whose outcomes you’re very concerned with? Why would you then has that business not be looking to technology to do some of the heavy lifting. And automate mundane, repetitive processes. And I’m aware that it’s more than a little self-serving to say. Now’s the time for ASC is to be evaluating technology that can genuinely help them because I work for a technology vendor.

I worked for doc, buddy, but it’s true. And today the ASC market is technologically underserved. There’s certainly technology and use. I’ll be the first to tell you there’s plenty of technology and you said ASC. At CS, but it’s serving baseline needs. Practice management software that handles your scheduling, your billing and your patient accounts. Hopefully, [00:18:00] you’re going a step beyond just the baseline though.

And you’re looking at things that can help you evaluate the profitability of cases. Things that can help you evaluate the cost of implants. Things that can actually streamline your operation because where you’re short staffed. Maybe you’re not so short staff with the right technology that can automate. Things like routine patient inquiries to the center. Think about it.

Or when you look at something like accounts receivable, which everybody has to deal with, there’s, there’s many reasons to have inflated AR some of it is on the payer. Look, we’ve already discussed the stonewalling, the unjustified denials. Some of those things are out of your control. But where can you accelerate your revenue cycle process?

Maybe that means looking at a revenue cycle partner. Maybe that means augmenting additional. I augmenting your back office with folks that have the right technology to speed claims through to approval. Maybe that means, and here’s where it gets really [00:19:00] self-serving. Maybe that means looking at a product like doc, buddy op note, which helps surgeons complete their awkward reports in moments after the point of care.

So that claim can then be generated and delivered to the payer.

Now is the time for ASC to embrace technology. Period. The entirety of healthcare has lagged behind the rest of industry for as long as technology has been in play in industry. Now is truly the time though. With all of these pressures, squeezing the ASC space, which again, provides tremendous value to patients. Provides opportunity to providers, to anesthesiologists, to all the staff at the ASC.

And it ends up being a cost-effective high quality outcome venue of care. The ASC is so badly needed for healthcare. That now is the time to adapt. Improvise and overcome all these challenges. And I, again, I want to reiterate technology, doesn’t solve [00:20:00] every single challenge at an ASC or any healthcare facility. But ASC is, should be looking at technology that can help them do more with less.

So on behalf of the entire dock buddy team, we want to thank you for listening. When the wish everybody celebrates a Merry Christmas. If you’ve already celebrated a happy Hanukkah, hope that’s been blessed for you. Happy new year. We’ll be back in 2024 with a new slate of guests for the DocBuddy journal.

We can’t wait to talk to you then. We’ll see you in January folks. Take care.