Becker's ASC Review

56 Becker's ASC 22nd Annual Meeting - The Business and Operations of ASCs – Call (800) 417-2035 H ere are five new services that will dif- ferentiate your ambulatory surgery center, from COO of Gramercy Sur- gery Center and Gramercy Healthcare Manage- ment Jeffrey Flynn. 1. Add lap band. Gramercy is the first surgery center in New York to implement a lap band pro- gram. "It's a safe procedure and a relatively small feat," says Mr. Flynn. "Given the issues with gastric bypass and malpractice risk, ASCs that want to re- invent themselves have to look at new procedures and this could be one of them." Although obese patients are typically considered "high risk," when the procedure can be done out- patient at the hospital it can also be done at the surgery center. Keep patient selection tight and form a good relationship with hospitals in case a transfer is necessary. 2. Offer prostate cancer services. "One of the most exciting things we're doing now is our ambulatory cancer care program," says Mr. Flynn. "It's open access. We started with our prostate cancer program, which patients like because we do treatment and then they can go home and sleep in their own beds." There aren't any emergencies with these treatments — they are all scheduled ahead of time — and pa- tients appreciate arriving at a healthcare institution that isn't chaotic like hospitals. "Patients like coming to the comforting atmosphere and we're doing these procedures at a lower cost than the hospital," he says. 3. Welcome Medicare patients. ASCs may stay away from Medicare and Medicaid cases be- cause reimbursement is low, but if the surgery center is efficient it can still turn a profit. "The hospital might not be able to make money on some of the outpatient Medicare cases, but an ASC can," says Mr. Flynn. The Medicare patient population could also put ASCs at an advantage if CMS goes more toward pay-for-performance. 4. Perform breast lumpectomies. Gramercy Surgery Center has a breast cancer program. People don't typically associate ASCs with breast cancer survival, but surgeons can perform lumpectomies in the more comfortable outpatient setting. "An ASC is ideal for these patients because the ASC has fewer infections and when cancer patients already have weakened immune systems, the less exposure the better," says Mr. Flynn. "There are fewer people coming in and out of the room, which reduces the risk of something going wrong." 5. Incorporate cardiovascular surgery. Ad- vanced technology has opened the doors for higher acuity cases at ASCs, including cardiovas- cular surgery. "I had a cardiovascular surgeon tell me in 2005 that only 8 percent of his cases could be done in the outpatient ASC," says Mr. Flynn. "Then in 2012 he told us around 70 percent of his cases could be done in the ASC." n 5 Fresh Ideas for Differentiating Your ASC By Laura Dyrda Dr. Richard Rosenfield: Creating the National Model for Successful Gynecology-Driven ASCs By Carrie Pallardy G ynecology procedures represent a fraction of the cases performed in ambulatory surgery centers, but there is a significant opportunity to change that equation. Pearl Women's Center and Pearl SurgiCenter in Portland, Ore., have been open since 2005. The clinic and surgery center are geared entirely to- ward women's health and gynecology surgery. Founder Richard Rosenfield, MD, began his medical career as a physician with Kaiser Per- manente in California, but never forgot his experience at surgery center during training. Frustrated with the restrictions of employment, he left to open Pearl Women's Center and the affiliated surgery center. For the past 10 years, the clinic and surgery center have flourished, but remain a relative anomaly. Simple gynecology procedures that had been done in the ASC were moving to the office and higher acuity cases stayed in the hos- pital. But, higher acuity cases in all specialties are migrating. "Bariatrics has come into view. Orthopedics and spine have become an exciting focal point," says Dr. Rosenfield. "Gynecology hasn't had its moment yet." But, he predicts that is all about to change. Hysterectomy is one of the most common pro- cedures performed on women in the United States, but it remains largely the province of hospitals. "It is not uncommon for hospital bills for hysterectomy to be in excess of $25,000," says Dr. Rosenfield. "We perform the procedures for a fraction of the cost." Payers are looking for the opportunity to push down costs, without sacrificing quality. Such a common procedure is ripe for the ASC setting, particularly as payer interest grows. Pearl SurgiCenter works with a mix of in-net- work and out-of-network payer contracts, but the center is poised to ride the growing wave of high-quality, low-cost healthcare. "On a case- by-case basis, we are saving any payer $5,000- plus per case," says Dr. Rosenfield. "When you attach the quality piece, they could be willing to pay more." He is also seeing increased in- terest from self-funded employer groups. Em- ployers funding their own health plans are in- terested in partnering with providers that can offer clear, consistent and reasonable pricing for quality care. Given Pearl Women's Center and Pearl Surgi- Center's success, Dr. Rosenfield is working on rolling out a national model for other surgery centers to follow. "I've been able to find inde- pendent physicians and align them with ASCs that can take them in," he says. "We have brand rolling out, backed by Nobilis Health in Texas." With branding efforts well underway, Dr. Rosenfield hopes to increase gynecology's pen- etration in the ASC industry. "We are looking for a quality product with decreased complica- tions. That opportunity in healthcare is golden," he says. "If rolled out responsibly, gynecology could be the next big thing in the ASC space." n Jeffrey Flynn

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