ASCA’s Diversity, Equity and Inclusion (DEI) Initiative (December 8, 2022)




In this episode of the Advancing Surgical Care Podcast, ASCA Chief Executive Officer Bill Prentice talks with ASCA Board President Mandy Hawkins about ASCA’s Diversity, Equity and Inclusion (DEI) Initiative. The ASCA Board of Directors approved a resolution supporting this effort at the association’s 2022 annual conference in Dallas, Texas, and work has been underway for several months. Prentice and Hawkins discuss the three parts of ASCA’s DEI Initiative: the ASC workforce, patient populations and the cultural competence of the ASC community. They also describe the work being done by 12 ASCA volunteers and ASCA staff to develop recommendations for the ASCA Board and, ultimately, the entire ASCA membership for future DEI advocacy and continuing education.

Narrator:   0:06
Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in delivering safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.

Bill Prentice:   0:37
Hello, and welcome to the Advancing Surgical Care Podcast brought to you by the Ambulatory Surgery Center Association, or ASCA. My name is Bill Prentice, and I’m ASCA’s CEO. In a moment, I’ll be joined by my guest, ASCA Board President Mandy Hawkins. Mandy has been a member of the ASCA Board of Directors since 2020, and previously served as ASCA treasurer. For the past 12 years, Mandy was also the director of The Surgery Center of Charleston in South Carolina, and on November 1, Mandy assumed the position of chief operating officer for Privado Health, a technology-driven ASC management company. And I’ve asked Mandy to join me on the podcast today for a discussion of ASCA’s new Diversity, Equity and Inclusion Initiative, also referred to as DEI. Mandy is spearheading this effort together with 12 other representatives of the ASC community and so I’ve invited her here today to talk about the goals for this essential effort. Mandy, welcome to the ASC podcast.

Mandy Hawkins:   1:33
Thanks for having me. I appreciate the opportunity to be here to talk to you today.

Bill Prentice:   1:36
Awesome. So, Mandy, I think it would be useful for our listeners to know how this initiative came about, and how you and our other ASCA colleagues are approaching this issue.

Mandy Hawkins:   1:45
The need for ASCA to formally address DEI issues has been a topic of a lot of conversations between both ASCA Board members and ASCA staff. This past spring at our annual board meeting, a resolution in support of an ASCA-led DEI Initiative was presented and unanimously approved. Since then, we’ve recruited 12 ASCA members to be part of three different working groups. The three groups will be looking at our employment in the ASC industry, the diversity of our patient populations and how we go about improving cultural competencies as healthcare providers. Our goal is to have recommendations ready for the ASCA Board to be considered by spring and before the annual conference in Louisville.

Bill Prentice:   2:25
Awesome. So, Mandy, let’s take these issues one at a time. So, the first one you mentioned was employment opportunities and opportunities for advancement in the ASC community. So, all across healthcare, there are persistent racial disparities. That’s true of nursing and especially true among surgeons and other physician specialists. That’s not a problem that ASCA can solve but we can certainly be an advocate for change, correct?

Mandy Hawkins:   2:49
That’s right, we need to advocate for change. ASCs can only hire the licensed professionals who exist in the workforce. And today, the workforce is neither diverse nor is it plentiful as we’ve all experienced and are still experiencing. All across the country, ASCs are struggling to recruit and retain staff and based on current projections, many experts believe that we’re headed for a serious physician and nursing shortage in the near future. The simple fact is we need to educate and train more medical professionals and greatly expand medical educational opportunities for historically disadvantaged Americans. And that can only happen with a commitment by the states and federal government to fund and provide these opportunities. Our working group will be studying legislative proposals, as well as proposals from other major healthcare organizations. And we will make specific recommendations for ASCA and ASCA members to become advocates for the best policies that we can identify.

Bill Prentice:   3:44
Well, and that’s really important because we know that these problems have been around for a long time, there’s no quick solution to them. And so, these legislative proposals, we can get them enacted and then probably it will require an infusion of dollars to get more training, more education opportunities to grow that healthcare workforce, and hopefully, in a very diverse way, so that our staff will reflect America, correct?

Mandy Hawkins:   4:09

Bill Prentice:   4:10
So, Mandy, the second part of the initiative that you mentioned involves looking at our current patient populations and trying to identify policies that could give underserved communities greater access to the value that ASCs provide. And as you and I have discussed many times, there are a number of factors affecting underserved communities and their ability to access ASCs that are beyond the control of the ASC. So, putting aside the ability to pay, which is obviously not an insignificant factor, ASCs have not historically been very viable in rural areas and inner cities where many underserved patients reside. And unfortunately, many lower-income Americans also have complicated medical histories and are not good candidates sometimes for care in an ASC because of our patient selection criteria. And when you look at Medicaid, nearly half of the beneficiaries are minors who are also not typically candidates for outpatient surgery. So, given all these limitations, where do our volunteers and you begin their work and analysis with this initiative?

Mandy Hawkins:   5:15
I agree with everything you just said. There are so many obstacles to serving these communities. Another factor to think about is that hospitals get compensated for indigent care and disproportionate share, or dish, payments that increase their Medicaid reimbursement. ASCs aren’t eligible for either program. It’s so unfortunate for us because every ASCA member knows that we are the lower-cost provider. In terms of our DEI Initiative, it’s clear we need to learn more about who we’re serving in our community, and who may be eligible to have surgeries or procedures in our ASCs that are currently being cared for in physician offices or hospitals. It might take us some time, but I think this research is going to help us make some informed judgments.

Bill Prentice:   5:55
That’s great. And to the extent that we’re looking for ways to, say, improve Medicaid, the challenge, of course, is that those decisions are made at the state level. So, we’re going to have to work state by state to try and, obviously, remove regulatory barriers and improve Medicaid payments if we’re going to try and have ASCs serve more of that population.

Mandy Hawkins:   6:14
We need that support from them, from the government.

Bill Prentice:   6:16
Yes, it’s going to be a long-term project, but again, a very worthy one. Mandy, I’m going to ask that we take a short pause to hear a brief message from our podcast sponsor. So standby, and we’ll be right back.

Narrator:   6:28
This episode of the Advancing Surgical Care Podcast is being brought to you by National Medical Billing Services, an ASCA affiliate and leading ASC revenue cycle company that helps ASCs properly capture their revenue and maximize their cash flow in a highly compliant fashion. To learn more about National Medical Billing Services’ wide range of revenue cycle services and analytics, visit

Bill Prentice:   7:00
So, Mandy, let’s now talk about the third track, cultural competence. And so, for anyone who may not be familiar with the term, cultural competence in healthcare is generally described as the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural and linguistic needs. Now, Mandy, I know you are passionate about this entire DEI Initiative, but I also know that this one part of our effort is where you believe we can really make a difference without relying on legislation or policy changes. Could you share your thoughts with our listeners about cultural competency?

Mandy Hawkins:   7:36
I am very passionate about this, and I believe it’s very important that we advocate for all three parts of our initiative. We need to expand our professional medical workforce, support policies that make us more diverse so we represent our multiracial and multicultural country, and the same holds true for the patients we care for and accommodate in more than 6,000 ASCs across the country. But these are heavily dependent on the support of the government at both the state and national levels. When it comes to cultural competence, it’s up to us in our community to embrace education and training needed to make us not competent only just medically, but in our interactions with our patients across the spectrum of language, ethnicity, religious affiliation, sexual orientation and many more. I see it every day in my own encounters with staff and patients. We’re seeing an increasingly diverse patient population, yet we have very little knowledge of the needs or beliefs that those patients present to us. Here’s the thing: by the nature of what we do, we’re compassionate and caring and we want to learn. What we lack today, myself included, is the tools. I am absolutely convinced that if we expand our educational offerings around cultural competence, there will be an immediate response in our community.

Bill Prentice:   8:47
I think that’s critically important and well stated because we do, I think, all grow up in our own kind of bubbles around cultural communities. And I think sometimes we get nervous around other cultures, other races, people with different physical or mental needs. And I think that the only way to overcome those is to really kind of tackle it head-on and spend time thinking about it and learning how to be able to communicate better with everyone in our community. So, I think this is a critically important task and I’m very appreciative of the task force tackling this one because again, as you mentioned, this is the one of the three that we can really start working on right now and develop that education and training. And we don’t need somebody else’s help, whether the government or a regulator, in order to try and succeed. So, that was a great overview of this task force, Mandy, and as I mentioned at the top of our conversation, this is an idea that the ASCA Board of Directors enthusiastically supports, and I know that they’ll be eager to hear the recommendations of those working groups. And I’m really looking forward to hopefully be able to provide some good information to our members around our annual meeting in Louisville in May. I also think it’s important to point out that while we need to see recommendations early in the new year that ASCA can support, we really need to be working to create a diverse, equitable and inclusive healthcare system. And that’s not something that’s going to happen overnight. So, as much as I would love to be able to say that we’re going to have this task force provide a report and that’s going to be the end of this work, I feel this is going to be a job that you’re going to be working on for years to come, well past your term on the ASCA Board and your presidency, and I hope you’re ready for that.

Mandy Hawkins:   10:23
I’m ready for it, it’s going to change the way that we care for our patients.

Bill Prentice:   10:26
I believe we need to make this a permanent part of our culture within ASCA and across the delivery system. Systemic change is going to take time and commitment and I’m just glad there is support in ASCA for being part of that chain. So, I want to thank you and your task force for your work. And I know the ASCA staff is ready to work with you as we tackle these enormous challenges. So, Mandy, do you have any final thoughts before we conclude the podcast?

Mandy Hawkins:   10:50
You know, it’s really time that we raise awareness and make a change. We have to be curious and recognize the differences among all these populations. ASCA supporting the DEI Initiative, and we’re having meaningful conversations. I don’t really think we’re doing anything on purpose or wrong, but we’re limiting the care that we provide in our ASCs. We need to provide safe, high-quality care to all patient populations and all diverse backgrounds.

Bill Prentice:   11:13
Agreed. Well, thank you, Mandy. This concludes our podcast discussion, and thanks for listening. If anyone has any thoughts they would like to share on the subject of diversity, equity and inclusion, or suggestions for future podcasts, we’d love to hear them from you. And finally, before signing off, I would like to once again thank our podcast sponsor, National Medical Billing Services, an ASCA affiliate and leading ASC revenue cycle company. To learn more, visit Until next time, please stay safe and thanks again for tuning in.