'Quality, luxury & profitability': The secret to this bariatric ASC's success

R&R Surgical Institute, an ASC in Torrance, Calif., has seen tremendous growth in the three and a half years since it opened and achieved accreditation through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program this year.

The surgery center is the brainchild of Ramin Roohipour, MD, a bariatric and minimally invasive surgeon, who made his vision a reality when the facility opened in August 2018. 

After more than a decade as a practicing surgeon, Dr. Roohipour estimated he has been to more than 30 surgery centers in Southern California and said most were not equipped to provide advanced and complex bariatric surgeries with overnight stay capabilities or the ability to address unforeseen complications. 

R&R Surgical Institute, which he said he believes is the only freestanding ASC in Southern California with the MBSAQIP designation and 23-hour stay capabilities for bariatric procedures, was "built through the eyes of the surgeon, with patient safety and comfortability central focuses, as well as profitability and cost containment," Dr. Roohipour told Becker's ASC Review.

With a focus on hotel-quality concierge care, the ASC has become a destination for bariatric surgery and regularly has patients travel from out of state, he said. Patients stay at a hotel adjacent to the facility, have their procedures in one of the facility's four integrated operating rooms and can stay in one of its eight recovery suites if needed.

"Our ASC's big picture was building a place where quality, luxury and profitability are met in one place," Dr. Roohipour said. "I'm proud to say that we've been very successful and profitable from day one." 

Operating almost like a mini-hospital, the multispecialty center focuses heavily on bariatric and bariatric revision surgeries but also provides gastroenterology, plastic surgery, urology and gynecology procedures, among others. 

Since opening, the ASC has had no mortalities, no major complications and no acute transfers to the hospital, according to Dr. Roohipour.

"We do 450 to 500 bariatric cases a year, and we do the same number of endoscopy procedures," Dr. Roohipour said. "We also do several hundred hernia cases, general surgery cases. After that comes urology. Plastic surgery cases are very minimal because they're mostly cash pay, which is not our focus. Our focus is through insurance and we are 100 percent commercial." The center also provides endoscopic thoracic sympathectomy surgery for a condition called hyperhidrosis, more commonly known as sweaty palms.

Citing HealthCare Appraisers' 2021 ASC Valuation and Benchmark Survey, Qemal Shaholli, director of operations at R&R Surgical Institute and Torrance Surgical Alliance, outlined that the facility's average collection per case, accounts receivable days and EBITDA margin are all above the 90th percentile, in addition to the number of days of operating cash on hand and inventory on hand.

The ASC has also managed to increase its case volume by about 18 percent compared with 2020 and — in anticipation of further growth — is interviewing surgeons to bring into the fold later this year. 

"We have a thriving general surgery and bariatric surgery practice that is interwoven with the surgery center and we try to directly hire surgeons to keep up with increases in volumes," Dr. Roohipour said. "Currently, we are interviewing surgeons who are coming out of fellowship in July."

Another key element that makes the ASC stand out from the crowd is its strong culture around superior patient experience, which comes from the top down, according to Mr. Shaholli.

"From the patient's initial engagement — whether it's on our website or over the phone — right through to our after care, we take that 'patient first' approach with everything we do," he said. "The team has collectively bought into this culture and it has yielded such strong returns for the patient experience. Our culture goes a long way toward our ability to retain and engage patients."

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