Becker's ASC Review

14 ORTHOPEDICS 1 orthopedic surgeon's recipe for a strong solo practice By Carly Behm A strong sense of personal responsibility and taking care of staff has helped orthopedic surgeon David Bailie, MD, run a successful practice with a cash basis model. A strong reputation is important to getting a cash basis model practice off the ground, Dr. Bailie, who owns Scottsdale-based Arizona Institute for Sports Knees and Shoulders, told Becker's. But there are other strategies that can keep it and other solo practice models thriving. Note: is conversation was lightly edited for clarity. Question: What are three pieces of advice you have for spine and orthopedic surgeons who want to transition to a cash basis model? Dr. David Bailie: Number one, treat the patient like they are your fragile child all the time even in the most routine case. en demand that same type of approach by everybody on your team. Do not delegate to anybody if you're going to go cash basis. You need to take responsibility from start to finish even if you trust your physician assistant. I trust the PA who has worked with me. She has been in the business for years and worked with me for years, but I close my wounds nearly all the time because I own that patient. Take personal responsibility, like your life depends on it, and this patient's life depends on it from start to finish, because it does. Number two, be fair and transparent — don't price gouge. If you've been in practice long enough, you know what you're getting paid from insurance and you know what you think is fair. So for rotator tear costs, I have a small, medium, large and massive fee schedule. If I get into a medium-size tear and I already charged the patient and it's way worse, I don't change the [price]. at's my risk for not being able to figure that out ahead of time. I'm fair and transparent with everything. I turn a lot of people away from surgery who are willing to pay because I don't think they need it. … Over time, that reputation gets even stronger. ird, you have to be lean in your overhead and remove all waste from how many staff you have to how you function as a clinic role and drain that you go to the office every day and or your staff is in the office every day. I pay my staff a salary. ey don't clock in and clock out. ey're paid 40 hours a week, 52 weeks a year on a salary. ey can come and go as you please. When I'm out of town, they can do whatever if the work's getting done and I don't hear a patient complaint. I don't want to worry about staff clocking in, clocking out, padding hours or being slow so they can get more hours being inefficient. And frankly I've only had two aer-hours calls in 10 years. n NYU Langone: How ASCs can easily add spine procedures By Carly Behm O utpatient spine surgery is growing, and some ASCs have a particular supply advantage when it comes to adding endoscopic procedures. Spine surgery overall has grown in the outpatient setting. Outpatient spine cases increased among Medicare patients between 2010 and 2021, with significant yearly growth at ASCs, according to a study in the March 2024 issue of the North American Spine Society Journal. But endoscopic spine surgery is still in the earlier stages of adoption in the U.S. Reasons for this include the learning curve that comes with mastering the technique and the financial aspect. For New York City-based NYU Langone, adding outpatient endoscopic spine cases has been an easier transition, spine surgeon Charla Fischer, MD, told Becker's. A key factor is that their outpatient centers already have most of the equipment that is needed. "If you have an ASC up and running and they're doing knee arthroscopes and shoulder arthroscopes, it's one extra tray to do a unilateral biportal endoscopy," Dr. Fischer, co- director of NYU Langone's endoscopic spine program, said. "[You don't have] to bring in another set of spine instruments and retractors. It's one small tray, and then I use all the same stuff that's already there." ASCs with a strong orthopedic foundation also might not have the same cost hurdles. "You don't have to buy a whole bunch of expensive equipment, which is so nice and an easy sell for administrators," Dr. Fischer said. "Oftentimes [we wonder if] we have a million dollars for this capital purchase for new technology. It's not a really new technology. It's just what the other guys are using, just applying it to the spine." n

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