'Healthcare has become a big cap business': What we heard this week

Healthcare providers recently spoke to Becker's about several topics, including physician ownership, CMS updates and hiring.

What we heard this week:

How is physician ownership changing in 2021?
Amar Setty, MD. CEO of Patient Premier (Baltimore): Physician ownership is decreasing in 2021. We are seeing greater trends toward employment of physicians. This is because of a number of interrelated factors such as mergers/acquisitions of practice management corporations, a growing push for hospital employment, increased costs of practice ownership and a desire for fixed hours or better lifestyle among younger physicians. The fear of declining reimbursement, combined with the complexity of new payment models, scares a lot of physicians toward employment. Healthcare has become a 'big cap' business, requiring market scale, data analytics and risk management — concepts that small practices cannot handle.

When will the backlog of colon cancer screenings subside?
Vonda Reeves, MD. Gastroenterologist at GI Associates & Endoscopy Center (Flowood, Miss.):​ The second surge of the delta variant of COVID-19 has created yet another delay in delivery of gastroenterology services. As a result, we have had to again shift schedules that are not yet back at pre-COVID-19 levels. It is fair to anticipate a 12-18 month recovery time with caveats of only minor surges of new variants, which are to be expected. Staffing changes, whether from ill employees, quarantine status or departure from the medical field, will influence recovery time. Unfortunately, all of the above will delay care and diagnosis of malignancy and other treatable gastrointestinal disorders.

Time for ASCs to be reimbursed the same as hospitals, Prime Surgeons CEO says
Gil Tepper, MD. Founder and CEO of Prime Surgeons (Los Angeles): CMS should change the reimbursement calculator on a basket of codes to put ASC and outpatient departments on a level playing field. They should use a transparent, unified fee schedule which applies equally to ASC and outpatient departments. They need to set a new reimbursement schedule that puts HOPD and private ASCs on equal footing.

Surgery centers, as small businesses, are clearly beneficial to the system — the success of ambulatory surgery as a discipline is critical to the benefit of the healthcare system in offloading the hospitals for more critical care. Today, the playing field is not level with reimbursement calculations using different indices between the outpatient department and the ASC — hospitals being reimbursed higher. This is a product of unfair and uneven lobbying size — with hospitals having much more representation on the lobbying side.

Personalities as important as resumes when hiring, say ASC leaders
Tiffany Jewell, RN. Clinical director of Wellspring Pain Solutions (Columbus, Ind.) and Columbus (Ind.) Pain Institute: When we interview our [prospective] employees, obviously we're really concerned about your skills, but more than that, we're really small — so getting the wrong person in here with the wrong attitude is detrimental. So as we're interviewing, we interview personalities.

5 CMS changes ASC leaders want to see
Vipul Nanavati, MD. Orthopedic surgeon at Idaho Shoulder to Hand Specialists (Boise): I believe we have transcended the need for hospital-based surgeries in many of the surgeries we do in the hospital-based setting, especially those that generally require no more than a 23-hour observation status. A particular example is total shoulder arthroplasty surgeries. The techniques, tools, surgical skills and time for surgery are now more akin to shoulder arthroscopic repair procedures in 2021. It would be nice to see Medicare be more responsive in releasing procedures across surgical specialties that can be done in the ASC setting in a more cost-effective and efficient manner. I believe CMS needs to be more responsive in expanding the list of CMS-covered procedures to the changing landscape of surgical procedures as their efficiency and efficacies are being proven in the ASC setting.

Gastroenterology's biggest threats
Christopher DiMaio, MD. Professor of Medicine at Icahn School of Medicine at Mount Sinai (New York City): There is a major disconnect between the explosion of innovative endoscopic tools and techniques, such as endoscopic submucosal dissection, minimally invasive internal drainage procedures, endoscopic weight loss interventions and the use of artificial intelligence to improve colon polyp detection, but no parallel establishment of procedure codes and reimbursements. Many of these procedures eliminate the need for surgery and/or improve clinical outcome parameters, yet in the current environment they are not billable, and thus they may result in major cost issues for patients, hospitals and providers. Ultimately, these factors will hinder their widespread adoption and thus availability to patients.

What ASCs want CMS to consider before issuing vaccination mandate
Joe Peluso. Administrator of Aestique Surgery Center (Greensburg, Pa.): CMS needs to provide clear and specific information, including appropriate safeguards to preserve access to care in local communities with adequate staffing. CMS needs to also provide adequate time and consideration for providers to come into compliance with any new mandate. The penalty for noncompliance will be removal from Medicare and Medicaid payments which would jeopardize providers' financial viability and threaten their ability to provide care to communities. Many healthcare providers are already experiencing severe workforce shortages, and a hasty mandate could prompt abrupt resignations of sufficient staff, prompting ASCs to suspend services.

ASCs run "mean and lean," so staffing shortages would create a major problem that would not serve the best interests of the patients in the local community or CMS. In addition, CMS needs to provide flexibility in the event of vaccine supply shortages, as well as exceptions for medical and religious reasons.

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