4 Key Lessons for Opening a Spine ASC

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When Robert S. Bray, Jr., MD, decided to open a spine-focused ambulatory surgery center, he had very few examples to look to for similar successful models. He founded and currently serves as CEO of DISC Sports & Spine Center in Marina del Rey, Calif. Dr. Robert Bray, Jr., founder of DISC Sports and Spine Center

Through trial, error and hard work, Dr. Bray and his team of managers and physicians have grown the practice into one of the largest sports and spine centers in the country for outpatient procedures. Since its opening in 2006, DISC has become the official provider of medical care for U.S. Olympic athletes and Red Bull North America athletes, as well as the Los Angeles Kings.

Here are Dr. Bray's four considerations before opening a spine surgery center.

1. Decide which model fits you best. Owning a surgery center isn't right for everyone, but it can provide freedom and control in an uncertain healthcare environment. The choice for most physicians comes down to hospital or surgery center affiliation.

"Am I going to be hospital owned and based or am I going to own my future?" Dr. Bray says of considerations to starting a spine ASC. "Hospitals aren't a bad place. They are doing what they need to do, but they have limits. In certain fields, especially spine, it's a better fit not under that umbrella."

Dr. Bray says he's much happier owning and operating an ASC, and the reasons for investing in the outpatient surgery center model are growing. His practice began with only 5 percent outpatient procedures and has grown to 100 percent. More types of spine surgery can be offered every year as technology improves and payors agree to reimburse cases in the outpatient setting.

"Without question there are going to be progressive expansions of the size, scope and complexity of patients done in an outpatient environment," he says. "The patients are going to go there and the insurers are progressively understanding that's where [the patients] are going."

2. Choose the right people to partner with. Before owning a spine surgery center, look for the right partners to embark with on the process.

"I caution people against doing what we did without finding really good people to do it with," Dr. Bray says. "It takes a lot of expertise to put together the whole big piece. You have to define your chunk of it."

He recommends expanding the management team from the start to properly allocate work for future growth. The challenge of finding the right team may seem daunting at first, but it will pay off eventually.

"I don't believe in the get-rich-quick scheme. I believe in building something to last," he says.

Once you have the right physicians in your center and a model to serve the needs of your market, the growth will follow. DISC started with four physicians and currently includes 40, with more being added every year.

"We are one of the largest sports and spine practice in the country and growing rapidly," he says. "Why? Because it works. People are happy; we are making money and getting good outcomes, and patients love us."

3. Take a calculated risk. The outpatient market is expanding, and owning and operating an ASC is a viable option for spine surgeons.

"Figure out the size and scope [of your center], take a deep breath and go for it," he says. "Build a long-lasting, quality, safe structure."

Hospital employment may provide a more stable practice option, but taking the risk of starting a surgery center is worth the reward, Dr. Bray says. Surgery centers are the future because they are meeting needs for surgeons and patients.

"They work," he says. "It's hard and it's a lot of work, but they make money. They grow, and you're happy."

4. Have a long term vision. Minimally invasive spine has always been Dr. Bray's passion, and after years of working in hospital structures, he knew he could deliver a better model for spine surgery. His outpatient practice started with simple spine procedures, and it became apparent more complex surgeries could be performed in an ASC setting.

Operating a successful spine ASC requires thinking about what the product could feasibly be and what the market needs, he says.

"Figure out what your niche is," he says. "Minimally invasive spine wasn't enough when I got started so we brought in sports and expanded to become hips and knees and shoulders. We chose a model to expand to our territory."

One of the biggest challenges Dr. Bray faced when he first opened his spine center was not knowing the size and scope he ultimately wanted the practice to become. He was thinking too small in the beginning and only growing a small step at a time. Some staff members were overworked, and the model needed to be adjusted.

"Really spend the time with experts to analyze the niche you want to take," he says. "I had my ups and downs. Now that a lot of information is out there, you don't have to make the same mistake again."

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