Becker's ASC Review

21 ASC MANAGEMENT Opening an ASC? What spine surgeons should know By Alan Condon T he migration of more higher-acuity spine surgeries to the outpatient setting presents an opportunity for stakeholders and surgeons to realize significant profit in the coming years if that ASC is operated properly. Currently, there are more than 180 ASCs that perform minimally invasive spine surgery in the U.S., with more spine-focused surgery centers expected to open. Market growth will be driven by the effects of the COVID-19 pandemic, the need to cut healthcare costs and physicians' desire to control the surgical environment. Here are three key items spine surgeons should know about opening an ASC: 1. Choose the right physician partners e first and most important aspect of open- ing an ASC, according to Kern Singh, MD, of Chicago-based Midwest Orthopaedics at Rush, is the right partners who you trust will dedicate the time and resources into making the surgery center a success. Central to the success of any surgery center is a core group of physicians who are committed both financially through an investment and to performing cases at the ASC. "Many people will want to be a part of the ASC once it's established, but the true value in your partners is when they start the center with you and help you deal with the growing pains," Dr. Singh told Becker's. 2. Decide on a management team/company Once you've got the right physician part- ners on board, the second step is find- ing the right management team, such as "venture capital firms and existing big ASC players who have reliably demonstrated the necessary traits for succeeding," according to Brian Gantwerker, MD, of Craniospinal Center of Los Angeles. Employed surgeons understand the com- plexities, turnover times and delays that are common in hospital operating rooms. Such issues, oen "written off as de rigueur at the hospital, will lead to a failed ASC," Dr. Gantwerker said. e management team is "almost as impor- tant as the partners you open the ASC with," Dr. Singh said. "[ey] help make critical decisions, including payer contracting, implant negotiations and hiring of essential personnel, including the director of nursing and surgical staff, which can make or break the efficiency of the center." 3. Identify an anesthesia group Another key component of establishing a successful ASC with great outcomes is find- ing the right anesthesia group to help run the center. "An anesthesia group well-versed in contempo- rary multimodal analgesia and outpatient spine and total joint arthroplasty is essential for the center to accommodate the increasing number of historically inpatient volumes that have now migrated to the ASC space," Dr. Singh said. It's also vital to ensure real estate costs and personnel expenses are in line with the payer reimbursements, "otherwise centers can be inundated with debt and may take many years to generate a successful return on investment," Dr. Singh added. e outpatient market is expanding rapidly, and owning and operating an ASC is a viable option for spine surgeons. Opening an ASC is no easy feat, but the reward can be worth the initial risk if stakeholders do their due diligence in the planning and development stages. n The avoidable ASC-killer that's eroding centers today By Laura Dyrda O ne of the biggest threats to many ASCs today is the staff's lack of operational and financial knowl- edge about the center. Tracy Helmer, BSN, RN, administrator of Seven Hills ASC in Las Vegas, coined the term "economic ignorance" and sees it as an internal threat. "[Economic ignorance] is a phenomenon where staff are not always aware of the financial needs for efficiency and prudent use of supplies, implants, etc., required to keep the ASC profitable in an environment where reimburse- ment is so much lower," she said. "Transparency and edu- cation of staff helps them learn how to provide excellent care in a cost-effective manner for our patients." Administrators can also fall prey to economic ignorance, Taylor Burnett, CEO of the Plastic Surgical Center of Mississippi in Flowood, said. She has seen the issue first hand during consulting work with centers where man- agement doesn't understand costs and reimbursements. These centers also often don't have dedicated staff to manage supply costs and reimbursement updates. "I also see a failure to value assets, including staff, on the subject," she said. "The cost to hire, orient and train new staff is staggering. Keep and value what you have. Good staff can 100 percent make or break you." The cost constraints for many ASCs have become more pronounced during the COVID-19 pandemic after centers adjusted to new protocols to safely perform elective pro- cedures. Melissa Hermanson, MSN, RN, CASC, administra- tor of Ambulatory Care Center in Vineland, N.J., said her center's financial recovery from the pandemic depends on efficiently using resources and containing costs. "Our administrative teams will need to continue to be creative in allocating resources, financial and human, to maximize efficiencies," she said. n

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