ASC Communications, Inc.

44 Executive Briefing CRH addresses anesthesia service needs at GI ambulatory surgical centers nationwide. With CRH as your anesthesia partner, you're able to take advantage of all our areas of expertise, including staffing, program implementation, and daily management of everything anesthesia related. We recognize that every practice is unique and that's why we don't have a "one size fits all" approach. Whether you're looking to monetize your current anesthesia business, would like to transition to deep sedation, or just want to bring anesthesia "in-house", our flexible partnership models allow our anesthesia services to integrate seamlessly into your center. At CRH, we are dedicated to working together with you to deliver only the highest quality of services to both your patients and your facility. Quite simply, our focus on GI anesthesia is what allows us to maximize quality and revenue in every area. From an operational standpoint, we have a dedicated QA/QI program which ensures quality of care, along with coverage offered by our vast network of experienced anesthesia providers. We are able to recruit as needed, schedule, train, etc., and we also have preferred access and pricing to Propofol. From a financial standpoint, in addition to an upfront majority buyout, we are able to maximize profitability through improved reimbursement and more efficient collections. We have been successful in all of our partnerships to date, increasing the value of the minority interest retained by the group, thus offsetting dilution as a result of selling. Lastly, as I alluded to earlier, this allows our partners to take some of the regulatory and reimbursement risk off the table. How are your partnership models tailored to suit GI practices with different needs? For groups that already own their own anesthesia business, we typically enter into a joint venture agreement allowing the physicians to monetize a portion of their business while continuing to benefit from the ongoing ancillary revenue stream. This future revenue stream (like other practice ancillary businesses) is often a physician recruitment incentive for the practice. Like the practice, the group has control of how partners enter/exit, which retains their autonomy. Lastly, the sale proceeds are typically taxed as long-term capital gains rather than ordinary income tax. I already mentioned our MAC development program, which is ideal for groups who do not currently own anesthesia. They may currently either outsource their anesthesia services or use conscious sedation. As the preeminent provider of GI anesthesia in the U.S., we do everything required to set up the new business, including staffing, advisory services, regulatory approvals, contract negotiations and so on, and then take over the day-to-day operations of the business. The clinical and operational benefits of using Propofol over conscious sedation is beneficial to both the physicians and their patients. The introduction of this line of business creates a new ongoing revenue stream for the practice and, at the conclusion of the first 12 months, CRH will buy 51 percent of the newly created company at a predetermined multiple. What are some of the hurdles CRH Anesthesia faces in its efforts to develop partnerships with GI anesthesia practices? Most often, it's just a matter of educating physicians on what we are offering and why it is worth considering a partner. This is especially true if they are unaware of certain events going on within the landscape of GI anesthesia. CRH Anesthesia keeps up on regulatory changes and reimbursement trends, which benefits our partners. Additionally, although it is not a frequent occurrence, there are sometimes misunderstandings about the legal structure of our transactions or partnerships. We spend a great amount of time on compliance and take a proactive approach in the implementation of safeguards to protect against regulatory concerns and incentives for overutilization. We have to review the regulatory aspects with the practice and its counsel, and ensure compliance with federal and state laws. Lastly, often it is just a matter of timing. Each practice is unique, and with all of the variables to consider, sometimes the timing simply isn't right. How important is it for physicians to be aware of the forthcoming changes to the anesthesia landscape and carefully consider their options? Now more than ever is the right time for GI physicians to explore their options when considering declining reimbursement and regulatory uncertainties. Healthcare is ever changing, and identifying the right partner with the right expertise is paramount to overcoming the challenges. The future independence of the gastroenterologist as we currently know it may depend upon it. n

• Cover