Becker's ASC Review

76 Becker's ASC 21st Annual Meeting – The Business and Operations of ASCs – Call (800) 417-2035 A mbulatory surgery centers and endoscopy centers are only as strong as their physi- cians. Five gastroenterologists weigh in on how GI physicians can become leaders at their centers and inspire their colleagues to do the same. Question: How can GI physicians become involved in endoscopy center and ASC leadership initiatives? Lawrence R. Kosinski, MD, MBA, AGAF, AGA Institute Practice Councillor, Managing Partner, Illinois Gastroenterology Group (Elgin): Since most ASC govern- ing boards and committees only function through the participa- tion of multiple volunteer members, they repre- sent a golden opportunity for younger physicians to involve themselves in governance/leadership. Committees are usually the first vehicle for young interested physicians who can work their way through the leadership up to governing boards. James Lee, MD, AGAF, St. Joseph Hospital, Orange, Calif.: There has been increased utilization of ASCs driven by lower cost to the payer and patient preference of ASCs over hospital-based outpatient centers as well as physician prefer- ence. Colonoscopies and upper endoscopic proce- dures account for almost a third of Medicare ASC spending growth between 2000 and 2007. Therefore, gastroenterologists are in the unique position to be- come the leaders in establishing ASCs. In order to establish an ASC, a physician has to delve into the business aspect of medicine. This process requires obtaining state licensure, becom- ing certified by payers groups and earning accred- itation. In addition, a physician might want to get a pro forma for his or her practice. For example, on the average an endoscopic ASC has to perform 2,000 procedures [each year] to make ends meet. Depending on the reimbursement rate the num- ber may fluctuate. Next step would be to decide whether to have a partner such as established cor- porate firm or the local hospital. It would depend on the specific relationship between physician and third party and if that relationship is neces- sary to get the ASC developed. Michael Sciarra, DO, Ambu- latory Center for Endoscopy (North Bergen, N.J.): Leadership initiatives in any organization are vital, especially when those lead- ership initiatives result in positive changes that positively impact efficiency, quality and profitability. A leader who also has a vested interest in the center tends to be more dedicated than one who "has no skin in the game" therefore it is beneficial to the center to cultivate and embrace such leadership when it presents itself. As for how can a physician become involved, the leader must lead by example. Hardeep Singh, MD, St. Joseph Hospital, Orange, Calif.: I think that as the paradigm of medical care is changing, and we have been more focused on controlling costs of the delivery of medical care. There has been a new emphasis on ambulatory surgical centers. Getting involved is not always an easy undertaking because it often takes the GI physicians taking the initiative to form an ASC and partnering with other physicians to make it a viable center. Often it is best to partner with an established company that can help set up the ASC. They can also help strategize based on the area that you are working, about which specialties to include and what types of cases would be best to do in the ASC as opposed to the hospital Christopher J. Vesy, MD, Texas Digestive Disease Consultants, Dallas Endoscopy Center: The first way physicians are going to get involved is by simply starting an endoscopy center or buying into one. As an owner, participation is necessary for success and getting physicians involved starts with requesting their leadership. It blossoms from there. I do think it's important to have the right leadership in the right place at the right time. For ex- ample, if your ASC has a surgical section, you want your surgeons to be involved in purchasing. Pick those people with a cost conscious mindset. Admin- istrators can reach out to get physicians involved, but there is a lot of power in physician leadership reach- ing out to other physicians. Q: What can gastroenterologists do to spark engagement in their fellow endos- copy center and ASC physicians? MS: To spark engagement in a physicians fellow ASC/endoscopy center colleagues one must estab- lish a "one-for-all, all-for-one" mentality. The fo- cus must be about the business relation they share and not interpersonal issues they may share. Pure objectivity is the best one could strive for and anything less just translates to degrees of failure. LK: The key to physician involvement is to create an environment in which their input is welcomed and valued. If an ASC is governed as a monarchy or an oligarchy, then there is no impetus for more physicians to engage in leadership. Democratic boards, with staggered terms for members, are the best model for building physician involvement. This will gradually elevate the knowledge of the members and create a platform for the better sharing of ideas. JL: Gastroenterologists can spark engagement in fel- low physicians by implementing a few steps. One is to increase control over their practices. In the ASC setting one can schedule procedures more conve- niently and it is less likely to have cases delayed com- pared to the hospital-based outpatient centers due to emergencies. Also by assembling highly skilled staff and equipments specifically designed for a par- ticular physician one can increase the productivity and efficiency of the individual practitioner. This will lead to increased job satisfaction and interest for continued utilization of the ASC. HS: GI doctors need to partner with other gastro- enterologists in the area. In order for an ASC to be viable, you need to generate enough volume of cases and access the right types of cases. That will require GI doctors banding together, sometimes with their competitors, as well as partnering with other specialties. Q: Are there any specific ways you've been successful in physician engagement? CV: There are a couple of different ways. I found this to be very successful: show physicians how their ac- tive involvement helps the ASC run smoothly. For instance, there is an issue with software. Offer phy- sician exposure to different vendors and ask them what works best. Another example: younger physi- cians may be used to life in a hospital where they can pick and choose everything. Leadership needs to help them understand what things actually cost and how it affects the surgery center. This involvement fosters cost conscious efficiencies in behavior. I've also found sparking engagement in younger physicians to be very important, especially when they gripe. In some settings, they may get their way by complaining — but that doesn't work in an ASC. You just create division. Talk to those physi- cians. Ask: "What would you do to make it better?" Sometimes you get a blank stare. Make them come up with a solution and then put them in charge of implementing it. Give them the power to make change. This is a really big learning tool. Q: How can gastroenterologists inspire both physician owners and non-owners to actively work towards improved ASC operations? JL: Gastroenterologists can inspire other physi- cians by continuing to strive towards improv- ing efficiency and improving the quality of care. One example would be to increase efficiency of the room. A frequent complaint is that the room is not ready soon enough leading to delay of the next procedure. As gastroenterologists we have the expertise to recognize which steps are needed and not needed in the patient care. By improv- ing efficiency gastroenterologists can inspire both physician owners and non-owners to work to- gether to improve ASC operations. Creating a Culture of Gastroenterologist Leadership in ASCs By Carrie Pallardy

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