Influencing the bottom line — Dr. Allston Stubbs on diversified caseloads, growth and major specialties

Several aspects go into successful ASCs, but offering a diversified caseload is among the most important.

Allston Stubbs, MD, an orthopedic surgeon at Winston-Salem, N.C.-based Wake Forest Baptist Health, shared his knowledge on caseloads and surgery center growth with Becker's ASC Review.

Note: This interview was lightly edited for style.

Question: Wake Forest Baptist Health offers procedures in a wealth of specialties, why is it so important to have a diversified caseload in terms of the bottom line?

Dr. Stubbs: In an environment of growing regulation and health care consolidation, caseload diversification is an ideal strategy for bottom line stability and growth.

While every healthcare market is specific to demographics, state regulations, and payer-leverage, the modern hospital system must have operational cash flow across multiple service lines to counter uncertain reimbursement, provider changes and evolutions in health care technology.

Each service line is only as effective as its ability to not only optimize revenue cycle, but to manage cost structure.

Diversification allows one to spread risk and consolidate administrative costs.

Further, health systems that offer a one-stop-shop advantage are more attractive to payor’s who can expect fewer barriers to patients seeking care under global fee agreements.

Q: How does your health system continue to grow its specialities?

AS: Our system not only delivers clinical care, but also has functions in research, education, and innovation.

Subspecialization continues as the knowledge base and complexity of the system increases. Subspecialization is best supported by a positive feedback loop among the research, education, and innovation fields.

As medical discoveries are made, technology transfer is paramount to capitalizing on clinical platforms which are defined by subspecialty growth.

The advent of minimally invasive surgery is an example where human capital was required to drive the technology forward and capture the value of shorter hospitalization, higher patient satisfaction and lower cost.

Q: If you were brought into a new surgery center and were tasked with implementing one of the above specialities, which one would you choose and why?

AS: All three subspecialties are winners; however, the amount of capital investment and fixed costs makes the field of orthopaedics less ideal for a freestanding center.

Both ophthalmology and gastroenterology have the benefit of lower fixed costs associated with implants, less intensive point of care needs and a greater breadth of treatment options.

While orthopaedic surgery is moving toward outpatient joint replacement, a greater scope of treatments within ophthalmology are possible on the outpatient stage.

Gastroenterology has a good fixed cost structure and can manage on a predictable schedule with high throughput. Finally, the move toward gastroenterology benefits from the technologies use as a screening tool as well as a treatment tool.

Learn more from Ms. Soule at the 24th Annual Meeting: The Business and Operations of ASCs in October 2017. Click here for more information.

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