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Live from New York: Perspectives from a Surgeon, an ASC Leader & a Policy Expert
2 Playsin 9 minutes
Recorded live at the New York State Association of Ambulatory Surgery Centers conference in Albany, NY (Oct 6-8), this special edition episode brings three vantage points on where ambulatory surgery is headed next: Dr. Daniel Choi of Spine Medicine & Surgery of Long Island on scaling a multi-physician practice with 10,000+ annual visits and what it really takes to plan an ASC; JoAnn Vecchio of ASC of Western New York on sustaining growth and continuity through a partnership with Catholic Health; and Kara Newbury of ASCA on how a federal shutdown could affect timelines and current legislation — and what ASC leaders should prioritize now amid uncertainty.
One theme connects them all: ASCs are built for this moment — safer care, smarter costs, and real runway for growth — if you can execute.
Resources mentioned:
Ambulatory Surgery Center Association (ASCA)
Brought to you by HST Pathways.
Recommended
Transcript
Podcast Introduction and Episode Overview
00:00:00
Speaker
Welcome to this week in surgery centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guest, and then we'll close the episode by recapping the latest news impacting surgery centers.
00:00:16
Speaker
We're excited to share with you what we have. So let's get started and see what the industry's been up to.
Live Episode at New York ASCA Conference
00:00:24
Speaker
Hi, everyone, and welcome back to This Week in Surgery Centers. Today's a special episode, which I actually had the opportunity to record live from the New York State Association of Ambulatory Surgery Centers Conference in Albany a few weeks ago.
Insights from Industry Professionals
00:00:38
Speaker
I sat down with three very special guests, a spine surgeon who built his own private practice throughout the pandemic, a veteran ASC administrator who helped transition her center from physician-owned to a joint venture with the health system, and then the chief advocacy officer at ASCA.
00:00:55
Speaker
So three very different roles within the industry, different perspectives, but one common theme throughout, and that's that policy tailwinds are in fact creating real growth opportunity within the ASC industry.
00:01:08
Speaker
First up, we'll talk to Dr. Daniel Choi, a board-certified orthopedic spine surgeon and founder of a growing private practice on Long Island. He's expanded from a solo startup to a multi-physician team across multiple locations with 10,000-plus annual visits.
00:01:23
Speaker
He's now planning an ambulatory surgery center guided by a simple question. Would I send my own family here? Next, you'll hear from Joanne Vecchio, the administrator of the Ambulatory Surgery Center of Western New York and a member of the board of directors of NISAC.
00:01:39
Speaker
For more than 25 years, she's led the center shift from ophthalmology only to a true multi-specialty center and recently helped guide succession planning that brought on a health system partner to scale operations, protect business continuity, and preserve community access to care.
00:01:56
Speaker
Finally, I'm joined by Kara Newberry, ASCA's chief advocacy officer, to discuss how a federal government shutdown could impact ASCs, potentially delaying the CMS 2026 final payment rule and other key legislation.
00:02:09
Speaker
We also talk about what leaders should prioritize right now in this moment amid so much pending change. It was energizing to have these conversations in person, and it was a great reminder that face-to-face time still matters.
00:02:21
Speaker
So today's format's a little bit different. You'll hear these interviews back to back, and then I'll pop in at the end for a quick wrap-up. I hope you enjoy the episode, and here's what's going on this week in Surgery Centers.
00:02:41
Speaker
I'm so excited to be sitting here with Dr. Daniel Choi. we're going to chat a little bit about some future plans that he has. So tell me first, Dr. Choi, a little bit about your private practice and what you do currently.
Dr. Daniel Choi on Starting a Practice During the Pandemic
00:02:51
Speaker
Absolutely. So I'm Dan Choi. I'm a board certified orthopedic spinal surgeon, and I started a private practice in Long Island, New York about five years ago during the COVID pandemic.
00:03:03
Speaker
And this was a pretty challenging time to start a private practice. Nobody was lending. I had a business plan that I shopped around. Actually about seven banks turned me down, even though Medical practice is like a bond, right? It's very safe.
00:03:17
Speaker
But at that time they weren't lending to any startups. So the eighth bank was M&T Bank. And one of their tellers sent my business plan up the chain and i was able to meet with them They gave me a five-year term loan.
00:03:29
Speaker
And i was able to start my practice. From a solo practice, we have now grown to three orthopedic spinal surgeons and two interventional pain management physiatrists.
Expanding from Solo to Multi-Physician Practice
00:03:39
Speaker
We also have a nurse practitioner, a physician assistant.
00:03:42
Speaker
We have now two locations and are growing to four this year with over 10,000 patient visits last year. So we're really serving a need in the marketplace. Right now, there's a lot of heavy consolidation and healthcare care we know in all marketplaces.
00:03:58
Speaker
And there is a big demand for private practice, believe it or not. Even though we see less and less private practitioners, patients seem to be seeking out the private practices that are left. and I think private practice, we can be more agile. We can move quicker. If patients are demanding it, ah we can meet those demands much quicker. So that's why I think our practice is growing.
00:04:19
Speaker
That's fantastic. And i understand that you're going to be expanding even more into the ambulatory surgery center space. So tell me a little bit about that. Absolutely. That's our hope.
Physician Shortage and Corporate Healthcare Impact
00:04:29
Speaker
We are currently in the planning stages of this right now.
00:04:32
Speaker
I would say that and I've written about this on various social media platforms that um we have a crisis looming in this country. And I think the one the biggest crisis in health care is our physician shortage. What you're seeing across 50 states is young physicians, now the opportunities for employment are all with corporate healthcare systems, right? It's either hospital systems or it's private equity, or it's actually insurers. UnitedHealthcare is actually the biggest employer of physicians in this country. 12% of physicians are employed by Optum.
00:05:08
Speaker
And Optum, many don't even know, is actually owned as a subsidiary UnitedHealth Group. With all this employment, what once was a profession where you had total control over your delivery system, your work environment, the employees you hired and how your patient care got delivered.
00:05:27
Speaker
That's now been controlled by corporate health care. And so you see physicians in that type of environment, they've lost their autonomy. And i don't think to their fault, it's just the way that legislation and and healthcare system has been shaped. It's been driven towards consolidation. And because of that, physicians are burning out earlier.
00:05:46
Speaker
um There's a lot of early retirement. There's physicians who you know, trained for 10 years, got to a place where they get to practice now. And they're saying, oh my gosh, this is not what I envisioned.
00:05:59
Speaker
And they're looking to get out. So there's actually physicians who are trying ah side gigs, like instead of your practice being your main source of income. Now there's a physician group called Physician physician Side Gigs on Facebook that has over like 20,000 members.
00:06:11
Speaker
And these physicians are looking for other ways to supplement their income and potentially off-ramp and get out of the practice of medicine. And there's a ton of discussion about this. This is a really sad thing for really are patients because the patients are losing out on ah ton of expertise. I mean, the amount of experience and training a board certified physician has to get to that point, we're talking about Immense resources, the education system we're talking about from high school level, pre-med college, med school, then residency. I mean, the amount of man hours that takes to train a surgeon or a primary care physician is immense and they're quietly exiting the workplace. And so I think that.
00:06:56
Speaker
Staying independent as a private practice is critical to alleviate that physician shortage.
The Role of ASCs in Physician Autonomy and Burnout Reduction
00:07:01
Speaker
And I would say that the Ambulatory Surgical Center is one of the key ways that I've discovered that private practices across the country have stayed viable.
00:07:11
Speaker
yeah Because what we hear about is that professional fees have always been going down and you see Medicare rate cuts to professional fees to physicians constantly every year getting cut.
00:07:22
Speaker
Whereas facility fees are actually either staying neutral or they're going up thanks to the lobbying of ah American Hospital Association and big entities that are keeping those facility fees.
00:07:33
Speaker
buoyed. You know, I think that private practices that have actually jumped on to starting the ambulatory surgical centers have stayed autonomous, stayed financially viable. That's critical. And then the working environment actually becomes one that is more physician-centric, in my opinion. And, you know, unfortunately, the hardest part about my week as a private practice doctor is actually stepping foot in a hospital look the hospitals are great they do a lot of things really well complex care icu care emergency room trauma centers but some of this stuff that we're doing in hospitals like basic elective surgical care doesn't need to be done in a 1200 square foot oh they can be done in a 500 400 square foot or in ambulatory setting they're usually being discharged the same day
00:08:21
Speaker
And that's the niche of the ASC to get these basic bread and butter cases in and out with higher quality, better safety metrics. You're not doing your case in a hospital where there's a life-threatening infection just next door. There's so many advantages to the ambulatory surgical center that I think are going to provide a lot of value.
00:08:40
Speaker
to the patients and also to the physicians. And, um and I think that the ASC is very key to potentially alleviating the physician burnout where physicians are not just operating in an outpatient setting that they like, they're get to operate within their cases. Surgeons get to do their cases in a setting that's very physician centric and driven.
00:08:59
Speaker
The ASC model is their customer is a surgeon. but They want to drive cases to the center. So theyre they're making sure that every part of that experience for the surgeon is very seamless and smooth.
00:09:11
Speaker
ah And that's why I think it's the future. Absolutely. i could not agree more. And we talk about this a lot, especially when it comes to anesthesiologists and the shortage there. How can we convince more anesthesiologists to come and potentially work at an ASC? How are you thinking about anesthesia? Is that something that you've given a lot of thought too how to approach that? Sure. We're in the planning stages. We've definitely thought about different options in the marketplace. How are we going to do it? Are we going to have an independent practice come in and staff the center they build for themselves? Are we going to bring it in house?
00:09:42
Speaker
Are we going to use different groups? We're playing around with different models. I would say that for me, the highest priority is patient safety. quality and making sure that we have great anesthesiologists that I feel really confident just bringing. i I think my metric for any decision I make for my center is what can I do to ensure that my family member, my family member, going to send them to this center.
00:10:06
Speaker
What would I want being done for my own family member? And i actually operate my private practice with that framing ah for every decision that I make. And that's served us well. a reputation for quality, safe care has really grown in the community and we want the center to be the exact same way. So, you know, we're leaning towards utilizing a private practice that I trust that I've already worked with. I know they're phenomenal. you know, I would want them. family to get taken care of them and bringing them in to be a part of our center. They would operate independently and they would be responsible for staffing and they would do all the billing.
00:10:41
Speaker
Obviously they would reap the financial rewards of being very reliable and staffing our center all the time. That's great. That makes perfect sense. I have another question related to kind of some of the legislative changes in New York. So a lot's happening and there's been a lot that's been talked about that's finally starting to be pushed forward.
00:10:58
Speaker
Do you see that as being an opportunity for your ASC, other ASCs? you think that's going to kind of shift the health care landscape in the state of New York?
Economic Influence of Healthcare and Market Consolidation
00:11:06
Speaker
No, absolutely. So I think that everything going on politically and in health care in general is that health care, I believe the spend now nationally, it's about 20% of our GDP. Yeah, that's absolutely mind boggling and actually Hospital systems are now the biggest employer in every state and every Metro you go to anywhere, Cleveland, Cleveland Clinic, they're the biggest employer. You go to Texas and all the big ah cities, they have a big major hospital system. In New York where I'm at, it's, it's Northwall. Northwall is one of the biggest employers in the state.
00:11:39
Speaker
Healthcare is such an economic driver and the spend is so large. And I think that what we've gotten to in, unfortunately, with some of the legislation that was written all the way back to the Affordable Care Act in 2010, is that we have driven healthcare care to be who were a bigger and bigger.
00:11:56
Speaker
Healthcare consolidation, right? We want these, all these tiny little hospitals to all get into one big system. We want it all the insurers. There's only two or three big insurance payers in every marketplace.
00:12:09
Speaker
So there are good things that can be done with big corporate entities. There's a lot that can be accomplished. Maybe you think it's more efficient. The capital deployment is more efficient because you have big sums of money that you can deploy.
00:12:22
Speaker
but there's also a lot of inefficiencies that come with consolidation. And if you think about just the free market, why do we have such a robust free market in America? You have anyone who thinks that, you know, that if they can run a a business that can meet the marketplace demands. You don't have to be Starbucks to run a coffee shop, right? can come in there and through your own sweat and hard work, build a cafe that is so much nicer and so much better and so much the coffee is so much tastier than Starbucks. You know this in your local marketplace and and in healthcare, care
00:12:58
Speaker
That is just not happening anymore. Doctors can't come out of training and feel like they can open up shop and open up a private practice that can serve the needs their community. And so what happens at any marketplace, and history has repeated this over and over, just basic economics 101, is that if you lose competition,
00:13:18
Speaker
prices increase, right? If you can't increase the supply, if people are not competing to try to capture the market and they're not working hard to be more lean, more efficient or higher quality, then the prices go up. You have fewer people that don't need to compete.
00:13:33
Speaker
And that's what's happened in American health care. You just see the competition cratering So you've seen prices go up. You've seen health insurance premiums every year, 20% higher, 20% higher.
00:13:45
Speaker
Families are now paying $24,000 to $30,000 a year in premiums. This is pre-tax dollars that could be going to their families. Instead, employers are also pitching in where their share of what they're, and you see this actually today, right now with the government shutdown. Yeah.
00:14:01
Speaker
All the buzz now is talking about what is the government paying for in healthcare care and why is the government subsidizing these premiums? Why have the premiums? And then everyone's starting to ask these questions. Like how crazy is it that we're paying 24 $30,000 a family in health premiums so And this all comes back to why is the ASC so critical in today's environment?
Cost Reduction through ASCs
00:14:24
Speaker
ASC has been proven time after time to bring down costs because it is introducing competition to the marketplace. It is a another place that the big entities that do surgery now have to compete with.
00:14:38
Speaker
They have to try to be just as good as the ASC or better or start their own ASCs to retain those cases. And when you introduce competition, prices will come down and the healthcare spend ah will be more manageable. Hopefully that's why I see that this is an economic no brainer that this is the future. Unless again, and America, we have a lot of regulatory capture, a lot of lobbying interests that go in and convince our policymakers that what is obviously correct is wrong.
00:15:10
Speaker
And what is totally wrong is the right way to go. exactly And we have these backward laws that have produced the mess that we have today. So we just hope that common sense will prevail and we can continue to introduce more competition to the marketplace through ases I love that. And hopefully the Medicare final rule that we'll hear about soon will continue to reinforce that procedures should be moving into these lower cost, higher quality outcome environments, and there will be even more momentum.
00:15:39
Speaker
Absolutely. Well, fantastic. I am so excited that you stopped by to chat. Thank you so much. I wish you the best of luck as you're building out your surgery center, and I can't wait to talk to you then when you open it. Thank you so much.
00:15:57
Speaker
Well, thank you so much, Joanne, for joining me. I know it's a busy day here at the conference, but i would love to just chat with you about your work and what you do If you could give me a quick introduction. Sure. Sure. My name is Joanne Vecchio. I have been in the ASC industry for about 25 years.
00:16:13
Speaker
I am the administrator at the Ambulatory Surgery Center, Western New York, which is in Ambers, New York, which is very close to Buffalo, New York. We are one of the largest ASCs. We were one of the first ASCs in our Western New York area. We have quite a few in the Western New York area, but we are one that's been in existence since 1999.
00:16:32
Speaker
We've been around a long time multi-specialty. um We still do pediatric cases at our surgery center, and we see on average probably between maybe 15,000, upwards of patients a year.
00:16:45
Speaker
That's awesome. And you have been with the ASC at Western New York for 25 years. So tell me about that. The industry has changed a lot and evolved a lot. How has things shifted in that know, the industry has changed a lot. We started at the ASC with a single specialty. You know, it started with a bunch of ophthalmologists that try to get out of the hospital for access reasons.
00:17:04
Speaker
We were seeing at that time, back in 1999, so many ophthalmology only centers starting with ophthalmology. And then I think it was somewhere around 2002 or 2003, we started to break into other specialties. Seeing that ophthalmology was great, but there was room for growth in the industry. And some of the regulatory things made it a little bit easier at that time to expand services. And, you know, to get the multi-specialty licensure in state of New York at that time was a different process, obviously.
00:17:32
Speaker
While things that evolve, we're constantly looking to expand services and ASCs. And, you know, I think one of the good things of all the people that are here at this conference are we're always striving to work together to try to expand the services that we are able to offer through safety and efficacy and can they be done and being fortunate enough to have the state organization behind us and listening to the members to say, hey, listen, we're thinking we could maybe do these at the ASCs.
00:17:57
Speaker
Let's work together to see what we could do from a legislative point of view to help us get these, you know, maybe recognized a little bit. So we're very fortunate. You know, at first, in a million years, you would have never thought you would be doing a total joint in an ambulatory center.
00:18:09
Speaker
You never thought in a million years you would be taking care of a pediatric patient that was under the age of 10 at an ASC. But we do it, all of us do it all the time and very safely. And, you know, with a very high level of throughput, with quality outcomes and patient satisfaction. I mean, parents will love to bring their kids to an ASC more so than a hospital, depending on what they need done. And the same thing with our adult patients. So we're seeing that expansion happen.
00:18:36
Speaker
More and more now. First, it was, you know, the ENT and the orthopedics with the total joints. You're seeing plastic surgery, a lot of bigger plastic surgery cases being done in ASCs where before they would be in hospital with the bigger mastopexes. And some of these mommy makeovers that you're seeing now that are really popular are being done in ASCs.
00:18:53
Speaker
And then there longer cases. So those are happening. And now we're on the precipice in this state of hopefully adding cardiology procedures to ASCs, which I think just brings a platform of growth to the community, not just to the ambulatory centers, but there's benefits here.
00:19:13
Speaker
for hospital-owned physician practices to expand and to be able to recruit into an area of New York that you're able to see your patients and have access to a hospital system and to an ASC.
00:19:24
Speaker
You know, I think those are things that are on the forefront for the ambulatory centers that I think are going to be great. Yeah, that's fantastic. There's so much exciting growth in the horizon. Yes. And you've had some changes at your ASC in the last few years. Absolutely. Tell me a little bit about now what it's like working with the health system.
Partnership with Catholic Health Organization
00:19:40
Speaker
So we were a offer freestanding, physician-only-owned ambulatory center started in 1999 by just a group of ophthalmologists that grew into a multi a multi-specialty surgery center. I'd say right before COVID,
00:19:54
Speaker
We were planning, doing our succession planning, and we kind of took a look at the list and said, hey, listen, guys, you know, how are we going to do this? How are we going to keep this place open? You know, we're all fighting time here, but there is going to come point in time where we need to make some decisions on how you want to move forward and in order to perpetuate the the business.
00:20:13
Speaker
it was decided amongst the group to go out and find a partner. And we are very, very lucky and very fortunate to find a really great fit within the Catholic Health Organization in Western New York. They have been outstanding partner for us coming in to support us from a regulatory point of view. When you are looking at this from an ambulatory site, you have this small group of people that you are relying on and you may have to call in consultants or work with other sites that you may or may not be able to work with. But Being able to partner with a larger organization that is a health system, not just a hospital, but a health system, it opened up access for us to be able to tap into resources that we never had before. Between regulatory readiness and compliance and physician education, all of the things that were shortcomings for our center.
00:21:04
Speaker
It's just because we didn't access to them, you know, and now looking at the changes that we are making because we are early on in the relationship, but the changes that we're making are so beneficial to the, not just to the owners, but to our staff and to our business line.
00:21:19
Speaker
I think that this is just a home run and we're so fortunate to be able to work with them every day, you know, on whatever it is, patient satisfaction and quality metrics, key performance indicators, all the things that before we're...
00:21:32
Speaker
so siloed to just our site. Now the benchmarking is there. We can see what others are doing and we have the support. And so I have to say it's been a positive experience. It really is good for this business. I think as we move forward to be able to lean in on a larger health system.
00:21:50
Speaker
Really the best of both worlds. You get all of the access to the scale that you didn't have before, but you can maintain all the benefits of working in an ambulatory surgery center setting. Absolutely. We're very fortunate that we are able to keep some of the autonomy. So we work very closely with the contract negotiations and we look at what is more beneficial for us and for the system. And we're able to kind of work together so that it's a win.
00:22:13
Speaker
Awesome. Very fortunate. That's great. Yes, that's great news. And let me just ask you this. What are you most excited about as you look ahead to all the changes on the horizon? Cardiac coming into New York, legislative change.
00:22:25
Speaker
What gets you excited about the industry? So many things get me excited in looking down the road. You know, there's a lot of challenges that we're going to be facing in order to get there. But I think that the cardiac is a big thing. I think maintaining a program of of excellence for the outpatient total joint procedures, as well as Being able to maintain the Medicaid population in granting access, additional access, you know, and an alternative site of service to the patients in the population of Western New York to be able to come to our center and know that it's safe and know that they have a place to come that's outside of the hospital. um And now being able to offer, potentially being able to offer cardiac procedures, I think is just going to be, you know, just going to be turned the whole thing upside down because, know,
00:23:11
Speaker
We are now able to offer these services, you know, whereas they may have been limited before or people may have been waiting before, but you know, and that's approve a proven thing with it like a pediatrics in the ANT.
00:23:23
Speaker
people may just not be getting those procedures. exactly Exactly. And, you know, being that it's an ambulatory center, we do have a flexibility of, you know, being able to add cases on late in the day. And, you know, the physician's satisfaction is there to be able to get the patients taken care of on the same day as they, you know, they have fracture and they need to get in right away or something's going on, you know, we're very fortunate to be able to often that.
00:23:48
Speaker
that's That's very exciting. It's fantastic. Well, I'm so glad that you stopped I'm so impressed by the advocacy work that the board of the association has been doing. i mean, it's just a really phenomenal example, I think, for other state associations to see how when the community comes together that you can really affect change in the state. I agree. And, you know, are're very fortunate ah at the board level and from the state association level to have such a diverse group.
00:24:13
Speaker
While we're all pulling in the same direction, there are different ownership models. Some are private equity, some are hospital-owned, some are still freestanding. You know, it's good to understand that we have everybody's point of view and everybody's voice is heard.
00:24:25
Speaker
was nice to meet you. And thank you for having me. We enjoyed the rest of the conference.
00:24:37
Speaker
Well, hello, Kara.
Government Shutdown Impacts on ASC Legislation
00:24:38
Speaker
Thank you so much for taking a few minutes to join me. I am excited to get to chat with you a little bit about what's going on at the federal level. We oversee all things legislative and regulatory for ASCA. So um there's some stuff going on.
00:24:51
Speaker
Fill me in. Yeah, so as of this recording, we are in a federal government shutdown. And so while that hopefully is not impacting access to care at this time, it could impact some things.
00:25:05
Speaker
um You know, federal payment rule is set to come out in early November. That could potentially be delayed. Surveys could be delayed. You know, the big picture also is the fact that legislation, both positive and negative, outside of just funding the government, is probably not being considered right now. One of the big pieces of legislation that ASCA has been advocating for is a Medicare beneficiary patient responsibility bill.
00:25:32
Speaker
Right now, hospital outpatient departments have a cap on what the Medicare beneficiary would pay. It's right now $16.76, and there's no such cap in the ASC. So if your Medicare beneficiaries are paying more out of pocket than $16.76 to have a procedure done in your ASC, ah they're paying more than going to an HOPD, which is counterintuitive, but that's what's happening right now. So we are trying to get a similar cap.
00:25:59
Speaker
to what the hospital outpatient departments have. So that's a big piece of like legislation we're proactively pursuing. There are a couple other bills that we have concerns with that we're pushing back against.
00:26:09
Speaker
So there's a piece of legislation that's been introduced in the Senate geared towards site neutrality. And I know on its face, a lot of ASCs think this sounds great and you know that they're going to get reimbursed what hospital outpatient departments get reimbursed.
00:26:23
Speaker
And that might be the case, but it would be because HEPs would come down to us. There's no discussions of increasing rates because the federal government trying to save money. It's all about going to the lowest common denominator. So we have concerns about that. And then physician offices are also part of that.
00:26:42
Speaker
And so for some codes, it might negatively impact ASCs and drop us to the physician rate. So we're keeping a close eye on those site neutral discussions and legislation that's been introduced.
00:26:53
Speaker
And then just price transparency is another big topic on the Hill. While we agree with transparency in general, and of course, want our patients to know how much they're going to have to pay to come to an ASC. What's being considered is really far beyond that. It's you know negotiated at rates, it's standard charges, it's the very specific rates that have been negotiated with payers.
00:27:17
Speaker
So we have a lot of concerns about that. And we don't think that it would benefit the patients or the public ultimately. So like I said, not probably likely that it's going to pass anytime soon and because they're focused on trying to figure out how to on the government. pitch Right. ah But those are some of the things that we're really keeping our eye on at the federal level. And just one other thing I kind of want to note, because it came down last month, there is a new CMS prior authorization um demonstration project. We're in New York right now. New York is one of the states impacted. There are 10 states
00:27:51
Speaker
And it's for 41 codes, primarily cosmetic, but there are some ophthalmic codes that are impacted and it would basically require facilities to go through a new prior authorization request.
00:28:05
Speaker
And although it says it's technically not mandatory, our sense is that if you don't do the prior auth request, chances are you'd be denied and then you have less recourse trying to get paid for those codes. That's slated to go into effect December 15th. We're writing a letter to CMS asking for a delay.
00:28:25
Speaker
We thought we needed more time anyway. And then with the shutdown and, you know, less resources, we think that it makes sense for that to be delayed. So we're optimistic that hopefully we can see a delay with that prior ro demonstration. but But, you know, considering the federal government is shut down right now, there still is, you know, a lot that we're working on, a lot going on.
00:28:43
Speaker
Is there anything that ASC administrators, leaders should be focusing on or thinking about at this current moment? I mean, i know that ASC administrators have so much on their plate, so much that they're worrying about and thinking about.
00:28:57
Speaker
I think that top of mind, we've got issues with anesthesia and the cost of anesthesia. And, you know, so we're trapping all that at the federal level and trying to help our facilities ah through different means.
00:29:08
Speaker
But i think that just keeping up with ASCA and your state association and knowing what's going on, I know that you all do a great job with these webinars as well, the podcasts. But just trying to, you know, stay up to date because things are coming down the line that will impact them, whether or not they're paying attention. But yeah, and people can always reach out to me if they have any questions.
00:29:31
Speaker
Oh, that's wonderful. We're so grateful for the work that Aska does and for the work that you do. Thanks, Kara.
Value and Growth Potential of ASCs
00:29:43
Speaker
Thank you so much for joining us live from the NYSAC conference in Albany. Three conversations and one common theme, and that's that ambulatory continues to prove its value and policy momentum is opening up a real opportunity for growth.
00:29:57
Speaker
From Dr. Dan Choi, we heard what independent medicine can look like at its best. He built a private practice during the toughest moment, scaled it to multiple locations and 10,000 plus annual visits, and is now planning his own ambulatory surgery center.
00:30:11
Speaker
His North Star of delivering patient care he'd want for his own family ultimately anchors the case for ASCs. Better access, strong safety, lower cost, and a physician-centric environment, which in turn benefits patients.
00:30:25
Speaker
From Joanne Vecchio, we got the long view of smart evolution. Over 25 years, her center moved from ophthalmology only to a true multi-specialty, then executed succession planning that ultimately brought in a health system partner, adding scale, resources, and benchmarking while retaining the agility that the ASC provides.
00:30:45
Speaker
She's bullish on what's next in New York, including cardiology and preserving access for Medicaid patients. From Cara Newberry at ASCA, we get insight into what the impact of a prolonged government shutdown could be on the ASE industry.
00:30:58
Speaker
We expect policy timelines to shift. Think the CMS, you know, payment rule for 2026, but there are other things in the mix, including a cap on Medicare beneficiary cost sharing at ASEs, site neutral proposals, which could push reimbursement rates down for everyone across the board.
00:31:14
Speaker
And of course, ongoing broader price transparency efforts. But the bottom line here on the policy and legislative front is stay close to ASCA and stay close to your state associations for the latest news and updates.
00:31:25
Speaker
So a big thanks again to my three guests and to you for listening, as always. I hope you enjoyed this episode. And if you did, please leave us a rating or a review on your favorite podcast platform to help others find us.
00:31:38
Speaker
We really appreciate you being here and we'll see you again next time.