Firm aims to disrupt ASC superpowers with new management model

In the shadow of growing giants like Dallas-based USPI, Brentwood, Tenn.-based Surgery Partners and Deerfield, Ill.-based SCA Health, a new ASC management model is emerging.

The big chains offer owners freedom from many of the responsibilities and headaches that come with running a business, but that often comes at the cost of ownership and control. For several years, the choice appeared to be binary for many owners and physician partners: You can relinquish control to get expert help running the business, or you can retain control and shoulder the burden yourself.

The space between those two choices is starting to fill in, however. Companies like Capital Surgical Solutions are positioning themselves as a much-needed "in-between" option.

CSS offers ASCs management expertise without handing down mandates. The company looks for ASCs with surgeons who want to be involved in operational decision making. When they find a willing partner who is a good fit, they acquire a minority position and then get out of the way.

"We have to be very selective about the physicians we pick, because we're giving them all the control," CSS Vice Chair Basheer Alismail told Becker's.

The approach may have a positive impact on patient care, according to CSS Chair Benjamin Stein, MD. Partner ASC Capital Orthopaedic Surgery Center in Germantown, Md., performed more than 2,750 orthopedic surgeries — including more than 1,000 total joints — in its first 18 months, while garnering 118 unanimous five-star Google reviews.

"There's nobody more vocal in improving the patient experience than the surgeons," Dr. Stein said. "When the surgeons have the ability to dial the knobs and invest in what they think is going to help patients, it translates. The [Capital Orthopaedic Surgery Center] shows it over and over again."

CSS is not the only firm that offers ASCs minority investment, but often even those partnerships are structured in a way that takes power away from the surgeons. 

"Physicians and payers alike are getting smarter about the ambulatory setting," Mr. Alismail said. "The second wave of spine, total joints and cardiovascular into the outpatient setting is really the catalyst to why you're seeing physicians raise their hand and say, 'Wait a minute, we know our worth, and we know it's more than what these big firms are willing to give us.'"

While the big firms continue to grow, CSS has placed a hard cap on its own growth in the interest of maintaining its personal touch. But if its boutique management model catches on, ASCs and surgeons could find themselves with a true spectrum of partnership options.

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