Becker's ASC Review

8 ASC MANAGEMENT How CON law shapes this ASC group's growth strategy By Patsy Newitt S ean Rambo, co-founder and president of Compass Surgical Partners, recently joined Becker's to discuss the company's new orthopedic ASC joint venture in Newport News, Va., developed alongside Bon Secours Mercy Health and a group of local physicians. e project offers a glimpse into how Compass navigates certificate-of-need laws, one of the most complex regulatory environments in the U.S., and how those laws influence its growth strategy. "With the CON laws in place, outpatient surgery is underserved and has an opportunity to migrate more out of the hospital setting — that's why we're excited about the market and working with Bon Secours," Mr. Rambo said. Compass sees opportunity where many see red tape. In states that require CON approval, such as Virginia, establishing a new ASC can be a long, uncertain process. "In regulated states — states with certificate-of-need laws — like Virginia, it's extremely difficult to get a new center through the CON process," Mr. Rambo said. "So in those service areas, we focus on acquisition." e Bon Secours partnership in Newport News presented what Mr. Rambo described as a "slightly unique scenario." Virginia's licensing framework includes a loophole that allows physicians to build what's called an "operatory" without a CON. ese facilities look and function like surgery centers but can only treat commercially insured patients, since they are not eligible for Medicare participation. "With Bon Secours, they had an existing CON in another part of the market that they could contribute," he said. "ere was no new CON — just a transfer. We could then acquire the business and convert it to a licensed surgery center, allowing them to bring both commercial and Medicare business out of the hospital." According to Mr. Rambo, this is one of the advantages of working with health systems that already have approved CONs and operating room capacity. ese hospitals "can look at transferring a CON into an existing operatory and converting it," he said. Compass Surgical isn't deterred by regulation. "Certificate-of-need laws certainly make it more challenging to grow rapidly, but they're also a barrier to entry," Mr. Rambo said. "Our firm was founded in North Carolina, which had aggressive CON laws — you just have to figure out how to navigate them." at experience has helped Compass build strategies suited for both regulated and nonregulated markets. In CON states, he said, development takes longer, but competition is also more limited. CON restrictions also shape the type of partnerships that thrive. "States with CON laws also struggle to have as many independent centers without health system partners, because of the politics around CON laws," Mr. Rambo said. For Compass, that reality has made collaboration essential. By teaming up with systems like Bon Secours Mercy Health, Compass can leverage existing CONs to expand access to outpatient care. "In these service areas," Mr. Rambo said, "we think outpatient surgery is underserved and has an opportunity to migrate more out of the hospital setting — that's why we're excited about the market and working with Bon Secours." n How this ASC balances technology investment with financial sustainability By Patsy Newitt J enny Bono, administrator of the Joint Replacement Center of Lake Charles (La.), joined Becker's to discuss how her team is navigating rising patient expectations for advanced technology while staying mindful of financial realities. Editor's note: This interview was edited lightly for clarity and length. Question: Do you have any tips for balancing the need to keep up with patient expectations for technology with the realities of investment? Jenny Bono: When it comes to EHRs, they're absolutely essential. We started with an EHR from day one, and I can't imagine operating without one. Being able to measure outcomes and use that data for payer negotiations or to improve operational efficiency is critical — it's hard to have those conversations without solid data. As for AI, we haven't invested heavily yet. There are so many tools emerging, and I want to see more maturity in that space before we make a major commitment. Our processes are still somewhat clunky and not fully integrated, but we're actively exploring ways to make them more seamless. Our biggest investment so far has been in robotics, which can be a bit controversial. Our physicians actually built this ASC around robotics — they could have continued using outdated hospital robots, but that wasn't their vision. They wanted a facility centered on advanced joint replacement technology. Of course, we carefully evaluated reimbursement and ROI. We're still a young organization, just three years old, so margins are tight. But robotics is central to our identity as The Joint Replacement Center and a key part of our long-term strategy. It wasn't about chasing profit margins; it was about defining who we are and delivering better care for our patients. n

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