Building an ASC management & development roadmap for the future

The surgery center market is booming, with technological advancements and the changing healthcare landscape paving the way for cases to transition to the outpatient arena. Joseph Zasa, JD, and Robert Zasa, co-founders and managing partners of ASD Management, are well-versed in the ASC space, having opened their first ASC management company in 1989. Joseph and Robert Zasa delve into the intricacies of what it takes to develop and manage a successful center in their book, "Developing & Managing Ambulatory Surgery Centers," which was published in 2016. The authors break up the book into the following four parts.

Part 1: Pre-development
The pre-development phase, which entails turning a vision into a reality, is key for any ASC developer. "Most ASCs are successes or failures before they're built. Certainly, there are exceptions. The point is that planning is absolutely critical to long-term success," according to an excerpt from the book.  

Planners have many options to weigh, such as their ownership structure; whether a joint venture with a health system will prove lucrative; projected supply costs; and legal fees that centers may accrue after opening. To successfully segue into the development phase, planners should map out the surgery center's legal and business principles. Employing legal counsel will guide planners through regulatory issues surgery centers may face. During the pre-development phase, using the expertise of individuals spanning many fields will be beneficial.

Past 2: Development
After detailing the basic principles to open a center, planners can begin the development phase. This phase centers on developing the system, process and standards necessary to operate the ASC. Joseph and Robert Zasa say planners should develop ASCs around four basic management cornerstones — patient care, risk management, business office and payer contracting.

The ASC industry is gaining traction due to centers' ability to provide optimal patient care, which is why a great deal of planning goes into ensuring ASCs will provide those outcomes. Centers collaborate closely with anesthesiologists, who work alongside both surgeon and nursing personnel to make sure all protocols are top-notch. The authors write, "From the very beginning, the anesthesiologist can lay the foundation for trust among the surgeons, staff and management, so critical to start-up and long-term success."

The development phase also includes risk management assessment in which planners identify state and federal regulations that apply to their ASC. It is crucial to know a state's specific regulations for licensing, employee wages and malpractice insurance coverage. When creating a patient safety program, planners should know state regulations for specific risk management components and reporting.
ASC owners and developers must also consider their business office processes. Setting up the business office system entails eight key parts:

•    Management information systems
•    Scheduling
•    Insurance verification
•    Coding
•    Billing
•    Accounts receivable
•    Accounts payable
•    Cash management

The healthcare environment is swiftly changing, and trends that used to yield profits may not work in the current landscape. Joseph and Robert Zasa recommend in the book to continually work with major plans on in-network contracts. When negotiating rates with payers, ASC planners should highlight their surgeons' quality as well as scope of specialties to achieve the best rates possible.

Part 3: Surgery center management
Some ASC owners opt to contract with an ASC management company, which may help them in areas like payer negotiations. Management companies provide surgery centers objective and independent oversight to ensure the facility meets its financial targets and improvement goals. The authors make a crucial point about the company's role stating, "The management company does not replace staff — it works effectively as an objective extension of the staff, fostering an environment where the staff can do their best and experience long-lasting job fulfillment."

The four cornerstones of management the authors laid out in the development phase are also important to consider in surgery center management. Centers will measure their quality using benchmarks and empirical metrics and will implement a series of checklists. Centers should also stay on top of their supply costs and product data so the center is sustainable in the long-term.

Part 4: Lessons from the field
In the final part of the book, many ASC experts share their pearls of wisdom on managing and operating ASCs. They touch on areas that are pertinent to surgery centers, such as recruiting new physicians and how to select patients that will fare well in an outpatient setting.

Through this management book, the authors strive to further the surgery center industry, stating, "It is our desire that this book contributes in a significant way to the ASC industry and serves as a point of reference for future leaders who will, in turn, further and augment the discussion of the development and management of ambulatory surgery centers."

If interested in learning more, you can purchase the book at

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