Becker's ASC Review

78 Becker's ASC 21st Annual Meeting – The Business and Operations of ASCs – Call (800) 417-2035 MS: Improved ASC/endoscopy center opera- tions should translate into improved profitability therefore the incentive will be inherent. The key to inspiring other physicians to contribute to im- proving operations is to make your partners un- derstand the fundamental relationship between quality and profit. LK: Again, the committee structure of most ASCs is designed to be the forum for the sharing of fi- nancial and operational information. Members of operations committees should do their home- work, ask intelligent questions and attend meet- ings in order to maintain engagement. CV: Ownership is partnership and non-owners need to understand that in order to become an owner, they need to demonstrate partnership skills. When I speak with GI fellows, I tell them that a business partnership is like a life partner- ship. You need to know how to communicate and work together. Give non-owners responsibility. See how they handle it. Q: What skills do GI physicians need to succeed as both clinical and business leaders at an endoscopy center or ASC? LK: There is plenty of educational material available for GI physicians to maintain a high level of busi- ness knowledge for their ASC. Becker's ASC Review provides a steady flow of information that is timely and available online. Specialty GI societies, like the American Gastroenterological Association, Ameri- can College of Gastroenterology and American So- ciety of Gastrointestinal Endoscopy, are also great sources of information. Some of us have pursued MBAs through the course of our careers; this can be a significant investment of time and effort, but for some of us it has been career changing. JL: One of the most important skills needed to succeed in ASCs is the decision making skill. Many decisions will have to be made prior to es- tablishing the ASC. One is the specialties involved. Would other specialties benefit from participat- ing in ASC such as orthopedics, ophthalmology, colorectal surgery or pain management? How can you maximize the utilization of the ASC among different specialties with different schedules? How many rooms will be needed and how many staff members would be needed to maximize efficien- cy of the center without sacrificing the quality of care? What equipment to purchase or lease? Most importantly what criteria are needed to hire staff? The decision will involve the number of staff, qualification of each staff, compensation and benefits. Personnel will be the largest overhead for the ASC, but also the most important factor in deciding the level of quality provided by the ASC. MS: Hard work, dedication to improving quality, smart business minded associates and willingness to anticipate market drift. Success also requires sacrifice at times in disproportionate occurrences, but sacrifice should be shared by all members at any given time to avoid resentment amongst part- ners, which is the death knell to success. CV: The number one skill is common sense. Close behind is hard work. You need to understand that your actions affect everyone around you and alter the ASC's ability to appropriately and efficiently care for patients. It is difficult to find people with a clinical and business mindset. Clinical minds are easy to find, business minds are not. Everyone wants to blame this on the fact that physicians aren't trained in business. Most physicians don't have time to gain a sense of business when they are spending 15 years to master the clinical. In a way, a busi- ness sense is innate. A lot of those skills are dif- ficult to teach. Not everyone has to be the biggest and brightest clinical AND business leader. So an important part of having business partners is putting trust in their skill sets — whether it's great patient relationships, clinical expertise or business acumen. HS: I think there has to be a focus on quality of care. If you are doing tremendous volume but patient care is compromised, the center cannot be successful. If quality and outcomes are kept at a high standard, and you can do an adequate volume, the center should remain busy. From a business standpoint, I think partnering with an established ASC company can really increase your opportunities for success. There are a few compa- nies that have a proven track record in this arena. They know how to analyze your specific geogra- phy, they can help analyze who are the best and most efficient physicians in the area to partner with, and they can also offset some of the risk, as they will usually take on some of the financial risk of setting up an ASC. Q: What are a few best strategies physi- cian-driven endoscopy center success? CV: You must always have a good administrator at your center. Even if you are there all day, you are primarily involved in the clinical work of the ASC during daytime hours. Without good administra- tion, your employees will not come together to run a successful center. Get involved outside of your center. State and na- tional ASC associations are a great way to make contacts — and contacts will promote different and better ideas — and build relationships with people doing similar things. Local, state and na- tional PACs or organizations like the American Society for Gastrointestinal Endoscopy, American Gastroenterological Association and American College of Gastroenterology are very meaningful and involvement in their activities is an advantage to your business. LK: Involve your members in the leadership pro- cess. Don't allow the governance to be dominated by only a few. We are all very intelligent and edu- cated physicians and most have useful ideas to share; we need a platform in which to do this. JL: Strategies for ASC to succeed have to be based on the reasons why there has been steady increase of ASC utilization. The number of Medicare ap- proved ASCs grew at an annual rate of 7.3 percent from 2000 to 2007 with Medicare payments to ASCs growing at 11.4 percent during the same pe- riod. One of the most important reasons for this is patient satisfaction, which is more than 92 percent. ASCs offer more convenient locations, shorter waiting times, convenient scheduling and lower co-pays. Also due to high volume of the specific procedures, there is increased quality with less complication. The nature of procedures favored by ASCs includes the most up-to-date and mini- mally invasive procedures that will benefit the pa- tients. All of these factors must be included in the strategy of establishing an ASC. HS: The best strategy is to partner with an ASC company. Another option is to engage a local hos- pital, to see if they may be interested in creating a partnership with the doctors, to help establish an ASC. That model has also been successful around the country as it keeps the hospitals involved so that they are not in competition with their doctors. Q: Why is GI physician leadership impor- tant in the endoscopy center setting? LK: Leadership is not a skill shared by all. It requires passion, education and drive. If a center has a recog- nized leader, they should provide that physician the environment in which he/she can thrive. The leader may need some protected time and even some supplemental salary to facilitate their growth. In the end, this is what is good for the group and for the ASC. Don't be penny wise and dollar foolish. JL: GI physician leadership is important in ASC setting for the opportunity for the growth of the center. Endoscopic procedures, colonoscopy and upper endoscopic procedures, were the largest drivers of the ASC growth accounting for 32 per- cent of the total charges in Medicare payments between 2000 and 2007. Colonoscopy has been firmly established as the preferred modality of co- lon cancer prevention. As our population becomes more obese there has been a seven-fold increase in the incidence of esophageal cancer over the last few decades. This may lead to increase demand for upper endo- scopic procedures in detection and treatment of esophageal cancers. As gastroenterologists we are in a unique position to contribute in providing the most efficient care at a lower cost to the society. MS: Physician-driven strategies are vital to im- provement in ASC/endoscopy centers because it is the physicians who are practicing everyday and have different perspectives on the industry than non-physician colleagues. HS: GI cases tend to be very high volume and there- fore it's important to have some of the GI doctors in- volved in the establishment of the center if possible. CV: The special thing about an ASC is the physi- cian leadership and ownership. Employees are go- ing to be really focused on pleasing the physician and that attention to their bosses' needs means better care for their bosses' patients. When there is no physician leadership or ownership, I don't think you get that special touch. n

• Cover