Becker's ASC Review

15 Executive Briefing: SPONSORED BY O pening a new ASC can be daunting. Surgeons are experts at providing outstanding medical care, but many are less familiar with the numerous components that contribute to a positive, patient-centered experience. Facility related considerations are critically important, such as maintaining product inventories, handling coding and reimbursements and bringing multiple service lines such as Orthopaedics, Spine surgery and ENT under one roof. Becker's ASC Review recently spoke to Vladimir Alexander, MD, founding partner of Alexander Orthopaedic Associates in Florida, about his experiences building and managing successful ASCs. He shared advice about what it takes to run a profitable venture, as well as insights about the value of trusted vendor partners. ASCs give surgeons complete control over the patient experience After completing his medical training in 2000, Dr. Alexander moved to St. Petersburg, Fla., and joined a physician group. He worked there for two years but felt somewhat dissatisfied because the group wasn't interested in growing and offering a more patient-centric experience. "After two years, I left and started Alexander Orthopaedics," Dr. Alexander said. "We saw our first patient in October 2002. This year, we'll celebrate our 20-year anniversary. The practice originally consisted of me and one physician assistant. Today, it's seven fellowship trained surgeons focused on orthopaedic sub-specialties, as well as eight physician extenders which include PAs and nurse practitioners." Alexander Orthopaedics also offers on-site physical therapy with three physical therapists and three physical therapy assistants, on-site MRI, on-site X-ray imaging and an in-office pharmacy. The practice now serves the greater Tampa Bay area, with locations in St. Petersburg, Largo, New Port Richey and Palm Harbor. "The organization has grown into the practice that I originally envisioned at the beginning of my career," Dr. Alexander said. "I stepped away from my first job and found that I was able to do it better on my own with the correct partners." For Alexander Orthopaedics, the journey to opening an ASC was based on careful planning and incremental growth. About three or four years after Alexander Orthopaedics opened, the practice realized it was running out of space. Dr. Alexander bought a piece of land about a mile away and built a new facility there. "We built out 20,000 square feet of space — 10,000 for our office and 10,000 for a learning center and ASC," Dr. Alexander said. "We waited to open the ASC, however, until the practice was busy enough to support that business." Initially, Alexander Orthopaedics had a corporate partner. After several years, Dr. Alexander recognized that having complete control over the business would support a better, more patient-centered experience. According to Dr. Alexander, "Everything that we've done in our practice is better now that we have control, because it allows us to focus on our patients. Corporate partners aren't the ones looking after our patients." After developing, building and ultimately selling multiple surgery centers, Dr. Alexander and Dr. Penello, Dr. Alexander's business partner, decided to launch a new company called SmartCare Surgical Partners that develops surgery centers. Their first center, SmartCare Palm Harbor, is scheduled to open in March of 2022 and will exclusively serve physicians who are part of Alexander Orthopaedics. Thus far, patient satisfaction has exceeded expectations. "We thought patients might be unhappy that their surgeon was an owner in the ambulatory surgery center where they were having their procedure," Dr. Alexander said. "We've found the exact opposite to be true. Patients are ecstatic that we have complete control over the facility where they are having surgery. Most patients think that doctors have control over the hospital where they perform surgeries, which is completely false. One facility won't let me use a certain cement because they think it's too expensive. When you do procedures in your own ASC, patients are pleased. They understand that what you're doing is best for their overall health, rather than a businessperson making fiscally based decisions about their health." Opening an ASC is easy, but staying in business is hard One major challenge facing new ASC owners is developing an appropriate pro forma. "This is very hard to do," Dr. Alexander said. "You need to identify the right case mix, insurance mix, patient mix and volume of surgeons. The appropriate mix is different for every center. Once you meet those criteria, you can develop the center, open it and generate the appropriate revenue and financial remuneration for doing your procedures there." Understanding operational issues is another hurdle for physicians that are new to the ASC business model. "Until surgeons do this at least once, they have no knowledge of Opening an ASC is easy, but staying in business is hard: Insights from Dr. Vladimir Alexander's 20 years of ortho practice leadership

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