Introducing a new clinical service line in an ambulatory surgery center is one of the most effective strategies for increasing patient volume and growing business profitability.
The Centers for Disease Control and Prevention has noted that the use of assisted reproductive technology doubled over the past decade, according to Dan Beuerlein, chief development officer and executive vice president of operations at Vivere Health, a fertility management and equity partner that assists in the development and management of ASCs and in-vitro fertilization laboratories.
Mr. Beuerlein referenced another CDC statistic stating that approximately 1.5 percent of all infants born in the United States every year are conceived using assisted reproductive technology. According to preliminary data that means more than 66,000 infants were born in 2013 as the result of ART.
IVF is one of the most widely known ART procedures. IVF involves combining an egg and sperm outside the body in a laboratory, unlike artificial insemination in which sperm is placed in the uterus, said Mr. Beuerlein.
Here Mr. Beuerlein discusses IVF services — a generally untapped service line in the ASC industry — and how it can be successfully added to an outpatient center.
Question: Does IVF lend itself to being performed in an outpatient setting? How so?
DB: IVF is perfect for the outpatient setting. Due to the nature of the process, the patients are typically young and healthy with few risk factors. The two primary procedures for IVF are egg retrieval (CPT 58970) and embryo transfer (58974). Egg retrievals utilize general anesthesia and embryo transfers are performed with local anesthesia. Additionally, diagnostic hysteroscopy and hysterosalpingograms, "HSG," are often performed as part of the fertility process. These procedures are minimally invasive, short in duration and patients can return to normal activity fairly quickly.
Q: What are some considerations for ASCs looking to add a new service line such as IVF?
DB: IVF is a very specialized service line, so the most important consideration is how well the patients, the physicians and the procedures will integrate into your existing facility.
IVF is a very emotional and expensive process for the patient and their family. IVF centers have traditionally remained independent to ensure a highly personalized level of customer service and privacy. Where most multispecialty ASCs were built with a one-size fits all approach, IVF patients and physicians are looking for a patient experience that is more refined than the traditional ASC will provide.
From the physician perspective, fertility is a very small world. Depending on the size of your market, there may only be five to 20 fertility physicians in the entire area. This requires a long-term commitment from physicians as the ability to attract additional fertility partners is limited due to the relatively low numbers of fertility specialists across the country.
In terms of facility requirements, it really depends on the services currently offered at your facility whether fertility procedures represent an attractive venture. If you're equipped for comparable specialties like general surgery, urology and gynecology, you'll be in good shape from an equipment standpoint.
Q: What are some of the biggest challenges of adding IVF services in an ASC? How can they be overcome?
DB: Some of the biggest challenges for adding IVF services include the physical plant or laboratory building, air quality systems and scheduling or staffing.
A fertility laboratory, typically ranging between 500 square feet and 1,000 square feet, is the key piece of the equation. The lab should be adjacent to and connected by a pass-through window to one or more of the ASC's operating rooms to facilitate an easy transfer of eggs and embryos. Not all ASCs have room for this type of expansion or the budget to convert existing space to accommodate a fertility laboratory.
Additionally, the fertility lab will likely be a completely separate business from the surgery center, so it will need its own dedicated waiting area and support systems. IVF labs also require extremely sophisticated air handling and purification systems that an existing physical plant or budget may not be able to accommodate.
One of the biggest challenges often overlooked in the planning process is scheduling and staffing. IVF centers operate on the weekends due to the sometimes unpredictable timing of egg retrievals. This can be a major hurdle from an administrative and staffing perspective. An ASC looking to expand into this industry must first ensure that the anticipated level of increased business will offset the increased expenses for part-time operating room and anesthesia staff.
Q: What are some best practices for adding IVF services in an ASC?
DB: I have found there are three best practices that help guide a successful IVF service expansion for an ASC. Firstly, don't try to be something you're not. IVF fits best in ASCs that offer a limited range of services to a similar patient population.
Secondly, find ways to integrate or co-market IVF with other specialties that provide services to a similar demographic like gynecology, urology and plastic surgery.
Finally, smaller IVF practices may or may not have their own laboratory or surgery center, so search for ways to bring multiple fertility physicians together into one joint venture.
Q: What advice do you have for ASCs looking to incorporate IVF services?
DB: I have a couple pieces of advice for any ASC looking to expand into IVF. First, do your research. Investigate how your current payer contracts treat IVF services. IVF is still a largely cash-pay specialty, but some payers may cover the cost of diagnostic procedures in advance of the actual IVF procedures.
Secondly, partner with an expert in the fertility industry to develop a realistic business plan that addresses key issues like lab design and construction; marketing and referral development; clinical compliance and accreditation; managed care contracting; and operational expertise.
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