Becker's ASC Review

5 ASC MANAGEMENT The new ASC president tasked with scaling a radical fixed-price surgery model By Patsy Newitt Z ionsville, Ind.-based WellBridge Surgical Center, a multispecialty, free-market ASC operating almost entirely outside the traditional insurance model, has named Tom Valentine — a leader with 30 years of experience in manufacturing — as president. Previously serving as the executive vice president of sales and marketing at Remee Wire and Cable, Mr. Valentine has spent his career working on profit and loss statements, statements of cash flows and balance sheets, but has never worked in healthcare. e owners, he said, made their expectations clear from the start: "We don't need you in the OR. If we see you with a bunny suit on, you're out of here." What they needed was an operator, which he said is exactly what Wellbridge's next chapter requires. "e role of president at a free market ASC is fundamentally about running the business," he told Becker's. "We're in the business of providing high-quality surgeries with excellent patient outcomes — but my job is to make sure that business is sustainable and scalable." WellBridge's unique model WellBridge is built around a fixed-price, all-inclusive bundle pricing model sold directly to self-insured employers. According to Mr. Valentine, it is the first facility in the country to have charge masters with both Anthem and United Healthcare covering a complete list of outpatient CPT codes at all-inclusive bundle pricing. e result on the patient side is a simplistic care experience. e same nurse takes a patient from pre-op through post-op, there are no visitor badges, no multistep check-in, and no separate facility, anesthesia or surgeon bills arriving in the mail weeks later. e center currently performs more than 14 specialties, including spine, ENT, women's health, plastics, general surgery and total joint. "e traditional reimbursement system rewards complexity rather than efficiency," Mr. Valentine said. "If your goal is to provide predictable, affordable surgical care, you eventually realize that operating entirely inside conventional insurance limits your ability to innovate around pricing and patient experience." Employer demand is growing e market WellBridge is targeting has reached a breaking point. Self- insured employers have watched their healthcare costs climb 6% to 9% year over year, with brokers promising savings that never materialize. "Employers are actively looking for alternatives because healthcare costs have simply become unsustainable," he said. "e market is creating the demand for models like ours." e pitch to employers is concrete, with a direct cost comparison that gives leaders a tangible, defensible number. Hospital systems pursuing direct employer contracts have inadvertently strengthened WellBridge's position, Mr. Valentine said. As those systems move to cut insurers out of the equation and pitch employers on direct pricing, payers have begun looking more favorably at lower-cost alternatives. "ere are a lot of self-insured businesses out there trying to find their way through the idea that they can significantly cut employee healthcare costs," Mr. Valentine said. "WellBridge is an answer to that problem, and I intend to prove the model works — and then take it elsewhere." Operational discipline the model requires Traditional fee-for-service complexity provides a financial cushion — missed costs, inefficiencies and variations in supply utilization can be absorbed or passed along. In a fixed-price model, none of that is available. "You have to understand your costs at an extremely granular level — implants, staffing, anesthesia, surgeon fees, supply utilization, room-to-room turnover times, everything," Mr. Valentine said. "In traditional fee-for-service healthcare, inefficiencies get buried inside the reimbursement structure. In our model, they can't. If you miss a cost, you can't send a supplemental bill. Your cost projections have to be right." When he arrived, the clinical side was already strong. e administrative and financial infrastructure was where the work needed to happen. "Clinically, I think ASCs are operating at an extremely high level," he said. "Administratively and financially, there's still a lag. A lot of healthcare is built around legacy reimbursement systems, no consumer expectation, and what I call the FUD factor — fear, uncertainty and doubt." Payer friction remains a reality even within WellBridge's model. "Behind the scenes, the surrounding healthcare ecosystem is still deeply fragmented," Mr. Valentine said. "Navigating payer rules, prior authorizations, staffing shortages, supply cost volatility, compliance requirements, constant reimbursement pressure — and then you send an invoice to a major commercial payer, wait 60 days, and they tell you they just hit send on the check when you called to ask where it was. ey're looking for any reason not to pay." Four priorities, one endgame Mr. Valentine is organizing his work at WellBridge around four priorities: scalability, profitability, staff retention and repeatability. Cross-training staff across 14-plus specialties is a significant investment, and retaining those people matters. e fixed-price model only holds if costs are controlled at every level, and none of it means anything unless the model can eventually be replicated in other markets. Communities with high healthcare costs and large concentrations of self-insured employers are looking for exactly what Wellbridge is offering. e biggest obstacle to that expansion, he said, has been surgeon recruitment. A decade of hospital consolidation has le many specialists contractually bound to health systems. "e hospitals have spent the last decade getting physicians under one roof, and now many surgeons are contractually obligated — no case leakage allowed," he said. "In orthopedics especially, those cases are longer and more profitable, and hospital systems know it."

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