The ASC industry in 2021: 15 key observations

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Over the past 18 months, ASCs played a critical role in the COVID-19 pandemic response. Now they are poised to take center stage as high-quality, low-cost providers within the value-based healthcare ecosystem. However, many barriers to growth exist.

During the Becker's ASC Review 27th Annual Meeting: The Business and Operations of ASCs, which took place Oct. 21-23 in Chicago, several experts shared insight on the key trends, challenges and opportunities within the ASC industry. Be sure to check out the virtual event, taking place Oct. 27-29.

Here are 15 key observations from the in-person event:

1. Independent ASCs are in an intensified war for talent. These centers were always up against the hospitals and health systems in their market, but now they are competing with hospitals' high-dollar signing bonuses and other aggressive recruitment tactics as the labor market continues its choppy recovery. 

2. Talent does not outweigh toxicity. Although they are spending great energy on employee retention, ASC administrators made note that it takes only one toxic person — regardless of their talent — to bring an entire team down. The need to address underperforming employees remains — and has even grown in importance — during the "Great Resignation." 

3. ASCs are battling for talent, and independent centers are looking for new ways to recruit millennial surgeons. Many younger surgeons are interested in more than just money. They want to know about what the ASC is doing for the community, the center's values and what steps the ASC is taking to create a diverse and inclusive team. 

4. What makes a great ASC administrator? A great ASC administrator has self-confidence and is passionate about their work. They also need to be effective communicators, organized and be able to juggle many tasks at the same time. 

5. Surgeons building strong relationships with referring physicians is a key way to drive business, and setting up virtual meetings can make this more efficient. Key questions surgeons should be asking referring physicians: To whom are you sending patients? Why? What can our ASC do to garner your business? Why are you not sending patients to us?

6. ASCs should not expect insurers to pay them more solely because they are saving money by moving procedures from hospitals to outpatient surgery centers. When approaching payers, administrators must do their homework and back up their cases with solid data to optimize the reimbursement they can receive. Having robust data and investing in technology to collect that data is also becoming increasingly important to running efficient operations.

7. While robotics are growing, ASC administrators approach their adoption with caution. In addition to costs, other factors considered before deciding to introduce a new system include case counts and the team's desire to use them. Several leaders mentioned the use of robotics largely as a marketing tool. Additionally, anytime a new line of procedures is introduced at a surgery center (regardless of robotics), it's mainly the same staff performing them, so it can be challenging to balance adding more services given labor shortages in the industry. 

8. However, to remain competitive, there might come a time when ASCs may need to invest in surgical robots, particularly for higher-acuity specialties such as spine and orthopedics. The next generation of surgeons are training with robots, and investment in these systems could soon be necessary to attract top talent. 

9. Many people who work in the ASC space are drawn to the surgery centers because of the more reliable level of predictability in their daily schedules relative to a hospital environment. Still, burnout is a huge challenge. Employees want more flexible schedules, but widespread staffing shortages make this difficult to turn into reality.  

10. The first step to mastering pediatrics in the ambulatory space is gaining buy-in and support from the anesthesia team. Practices must also ensure staff members are properly trained and comfortable working with pediatric patients. Patient experience must be top of mind as well, as something that might seem routine for an adult can be scary or disconcerting for a child.

11. For many independent ASCs, partnering with larger organizations might be the best way to ensure sustainability in their markets. However, leaders considering joint ventures should avoid transactional relationships with potential partners by ensuring organizations are clinically and culturally aligned.

12. Profitable specialities ASCs should think about, if they aren't already, are: spine, total joints, bariatrics, cardiovascular, GYN and ENT. But it's not just about specializing in these areas, it's also about finding the right people who specialize in these areas.

13. Ways to address nurse staffing shortages at ASCs: Have informal partnerships with administrators who can send any new and eager nurses to help out. This way the nurses who are early in their careers can get extra experience while allowing ASCs to build a pipeline for talent and filling staffing needs. Another way is to focus on long-term results rather than short-term staffing holes, otherwise facilities could end up with nurses/staff who might not stay too long or who don't fit the culture or match the excellence of care.

14. Key trends affecting pain medicine specialists include increased adoption of telemedicine, receiving more referrals sooner, increased diversification and growing regulatory and licensing challenges. While pain practices can be successful on their own, practices that find a partner or investor will do even better.

15. New ASC administrators should lean heavily on the broader surgery center community in the early months of their tenure. The ASC business is complicated, but the community is supportive and replete with educational opportunities. Seasoned ASC administrators cite conferences and virtual workshops as essential to their early success. 

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