When it comes to building a successful ASC or physician practice, most conversations start with capital, location or case mix. But for Basheer Alismail, president of ASC and physician practice company Capital Surgical Solutions, alignment should be the first consideration.
“The most important thing we’ve learned — having come from the ASC side first, then moving into practice management — is alignment,” he said. “Specifically, transparency about where a physician or physician group falls on the spectrum between quality of life and economic interest.”
In his experience, physicians generally fall into one of two camps. Some view the ASC primarily as a quality-of-life play, such as a way out of the hospital, more schedule flexibility or a distribution check when it comes. Others, who he calls the “alpha physicians,” are focused on optimizing the financial returns of the ASC as a meaningful part of their overall wealth strategy. For Mr. Alismail, those are the partners worth pursuing.
“Those are the partners we work hardest to align with,” he said. “From a business perspective, they’re the ones who drive success. And that transparency also helps us as an operations team actually define what success looks like. The quality-of-life dynamic is harder to quantify.”
It’s important for both parties to be transparent about what they’re looking for, he said. When a physician can clearly articulate what they want out of the venture, defining success becomes straightforward. The quality-of-life motivation, while valid, is harder to build a strategy around.
Identifying the right partners is also about recognizing warning signs early, Mr. Alismail said. The Capital Surgical Solutions team has developed what he described as four gates every potential partner needs to pass through.
The first is the ability to make decisions.
“If a physician vacillates constantly or expects us to answer every question, that’s not the right partnership,” he said. “We need their intangible value — their judgment, their clinical standards, their reputation — to come along with them.”
The second is a genuine partnership mindset. Physicians who want to own everything and employ everyone, rather than share in something collectively built, have consistently been the wrong fit.
“We’ve stubbed our toe on that,” he said.
The third gate is being data-oriented — willing to make decisions based on information rather than emotion. The fourth, learned the hard way, is more procedural: background checks.
One reason the vetting process works, Mr. Alismail said, is that his partnerships develop slowly by design. On the ASC side, there’s typically a three-year runway from initial partnership development to first case. The practice side moves faster, around six to 18 months, but the principle is the same.
“A lot of it is word of mouth,” he said. “Having a physician partner who can do peer diligence differently than I can — going to a colleague and asking whether someone has the operational mindset for outpatient surgery — is invaluable.”
That long development cycle is how alignment gets tested. By the time a first case is on the schedule, there should be very few surprises about who you’re working with.
Capital Surgical is not trying to scale broadly, Mr. Alismail noted. The model depends on remaining selective about partnerships.
“We don’t go in blind. We spend significant time ensuring aligned interests before anything is formalized,” he said. “What we do takes longer, but we earn those relationships rather than buying them.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.