A rookie's guide to opening an ASC

As ASCs become increasingly enticing to health systems, investors and physicians alike, some healthcare leaders who are not as familiar with ASC practices may be looking to open outpatient centers.

Becker's connected with six ASC leaders to see what advice they would give to someone looking to open an ASC. 

Note: These responses have been edited lightly for length and clarity.

Question: What advice would you give someone who wants to open their own ASC?

Shakeel Ahmed, MD. CEO of Atlas Surgical Group (St. Louis): Having run around a dozen ASCs over the last two decades, here are my best tips for ASC owners: To ensure the sustainability and profitability of your business, it's crucial to keep operational costs under control. One effective strategy is to focus on specialties that are associated with lower surgical expenses, allowing for a more efficient allocation of resources. This approach not only enhances financial efficiency but also positions your business competitively within the market.

However, it's important to balance cost-saving measures with the quality of care provided. Staffing is one area where compromises can have significant negative impacts on both patient outcomes and business reputation. Prioritizing both cost management in service offerings and excellence in staffing is key to a robust and thriving operation.

Daniel Chan, MD. Chief of Orthopedic Surgery and Sports Medicine, Medical Director, Orthopedic Trauma at Memorial Healthcare and Medical Director of Joint Replacement at Cypress Creek Outpatient Surgical Center (Fort Lauderdale, Fla.): There are many factors to consider when opening a new ASC.  Having a solid understanding of the local landscape in terms of patient demographics, potential hospital and ASC competitors, payer mix, and surgeon workforce is critical. Significant barriers remain to opening a successful ASC from the ground up, and apart from initial build-out costs, securing top-quality staff and especially favorable payer contracts remain challenging. 

Ideally, there will already be a core of committed physicians who are ready to bring high-margin cases immediately to the new ASC and are already comfortable with high-volume outpatient surgery in their selected subspecialties.

Finally, selecting the appropriate management/investment partner will likely be the single most important factor in the success of the ASC.  The management partner will dictate the culture of the ASC, drive physician engagement and recruitment, facilitate marketing efforts, help procure favorable insurance and vendor contracts, and maximize operational efficiencies.

Kurt Duncan, MD. Orthopedic Spine Surgeon at Twin Cities Orthopedics (Minneapolis):  Make sure you include orthopedic surgeons in your ASC. And make sure that any value-based care programs at your ASC reward the facility and not just the surgeon for good outcomes

Jay Mackey. CEO of Occu-Health Surgery Center (Houston): My advice would be to explore what differentiates your ASC from others in the industry.  Determine how you can compete or collaborate with large physician groups who could drive volume to your center, or support your volume if you’re bringing the cases. What does that look like from an incentivization perspective, and it is practical for you and your partners? Become an expert in billing and contracting. The lifeblood if your facility is your ability to collect for services that you’re providing. Equally as important is to consider cost-effective vendors for implants. You can’t allow a surgeon's preference to be the reason a case loses money. Lastly, effective communication and your ability to promptly return notes to your referral sources will, and can be, the lynchpin for your success.

Kristin McCann, MSN, RN. ASC/Pre-Admission Testing Nurse Manager at United Health Service Hospitals (Binghamton, N.Y.): I would have to say be open to introducing new service lines. For example, here at United Health Service Hospitals, we recently introduced cardiac services to the ASC. We increased access to care for our patients needing cardioversions, loop implants/explants and coming soon, generator changes. Adding this service to our ASC has allowed increased access to care for our patients while giving the nurses the ability to utilize their skills to sedate the patients for their procedure. 

Vladimir Sinkov, MD. Founder and CEO of Sinkov Spine Center (Las Vegas): I would give them the same advice as anyone opening a new for-profit business:

  1. Make sure there is a market for your product – if your area is already over-saturated with ASCs, opening another one might not be the best idea.


  1. Make sure you can be profitable within a reasonable amount of time – explore what are the dominant payers in your market and what type of reimbursement you could count on.  Then evaluate the costs of running the ASC and decide if the reimbursement levels would support that.


  1. Make sure you have adequate staff to run the business – for ASC that means finding administrative and clinical staff to run it as well as a sufficient number of physicians that would be willing to perform surgeries and procedures at your ASC. 


  1. Control overhead costs – negotiate reasonable rates with medical supply and implant vendors and create policies to avoid unnecessary waste.


  1. And of course, make sure your ASC is accredited and complies with all federal, state and local laws and regulations.

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