ASC Expansion: Making the Leap From Single-Specialty to Multispecialty
Larry Trenk, a regional vice president of USPI and president of the New Jersey Association of Ambulatory Surgery Centers, describes the process of bringing orthopedics, podiatry and pain management to the center and offers insight for other single-specialty centers considering a foray into the multispecialty realm.
Assessing the need
Adding a new specialty, or three new specialties, is an appealing step for a single-specialty ASC. New specialties can increase case volume and revenue, but this type of expansion project is a classic case of "look before you leap." "Do your homework and study the feasibility [of the project]," says Mr. Trenk. "Weigh your ability to do each case."
In the case of the Endoscopy Center of Bergen County, the upswing in GI case volume resulted in the addition of an operating room. The center now has three active ORs and a fourth waiting in the wings for future occupancy. Orthopedics, podiatry and pain management were a natural fit because local physicians in those specialties were looking for a place to operate.
"Clearly the idea of 'build it and they will come' does not work," says Mr. Trenk. Though the centers leaders are continuing to seek more physicians in its new specialties, the ASC had enough physicians to justify the addition of the new service lines.
The key for any ASC seeking to add a specialty is a solid physician base. "Do not go after one physician," says Mr. Trenk. "You want a critical mass of physicians in a specialty to justify the expense." A single physician could decide to leave a center; four to five physicians per specialty creates a larger opportunity for success.
Bringing physician-owners on board
New specialties, especially for a single-specialty GI center, can dramatically change how an ASC operates. Physician-owners need to prepare for those changes, as well as the financial aspect. "Impress on current physicians that the incremental volume new specialties can bring is worth doing," says Mr. Trenk.
Thus far, all of the physicians at the Endoscopy Center of Bergen County, a total of 40, and their cases have been accommodated through block scheduling. A significant number of pain management cases have been done already, while orthopedic and podiatric volume is building more slowly. "If these physicians have the opportunity to ramp up their volume, there is a possibility they will be interested in investing in the center," say Mr. Trenk.
If an adequate physician base has been acquired, the next consideration is the necessary equipment to make the new specialties possible. The Endoscopy Center of Bergen County had a considerable amount of equipment to acquire. A C-arm and various shavers, drills and scopes were needed to accommodate orthopedics, podiatry and pain management cases.
Another consideration is how the new equipment will fit into the physical space of the center. "Think about storing the equipment. How will you maintain it?" says Mr. Trenk. This may be an overlooked consideration, but it is an important one that will affect turnover time and the center's overall level of organization.
GI centers have quick patient throughput and fairly uniform patients. "Everyone is conversant with the process," says Mr. Trenk. But, when you throw in one or more new specialties the staff has a whole new set of processes to learn. Prepping, scrubbing, use of equipment, OR protocols and patient release all take on new meanings with each different specialty.
USPI has a number of centers, which allowed the Endoscopy Center of Paramus to learn from the best practices of established orthopedics, podiatry and pain management-driven ASCs. Whether under the umbrella of a large ASC company or not, any single-specialty center can reach out to industry contacts for thoughts on staff training and best practices.
Managed care contracting
A larger revenue stream is one of the main factors driving single-specialty centers to expand to multispecialty. How large this revenue stream can be rests on managed care contract rates. "[For single-specialty centers] managed care rates are specific to the cases you have for that one specialty. Frequently, you focus less time on rates for specialties that are not your bread and butter," says Mr. Trenk.
For the Endoscopy Center of Bergen County, managed care rates for orthopedics were the biggest consideration. "Orthopedics is a whole different ball game," says Mr. Trenk. "We are still working through the process." While wading through the contract negotiation process, case selection is a delicate process. For example, if a center has not achieved beneficial carve outs with a payer, a complex ACL case with expensive implants is most likely not a good fit.
"If you bring news specialties to an ASC with finesse, it can definitely be beneficial," says Mr. Trenk.
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