Danilo D’Aprile, president-elect of the Arizona Ambulatory Surgery Center Association and vice president of business development at Merritt Healthcare, joined Becker’s to discuss what this relationship looks like in Arizona.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What does the relationship between ASCs and these growing hospitals and health systems look like in Arizona?
Danilo D’Aprile: Hospitals have recognized that ASCs are not competitors, but rather strategic partners. While hospitals may lose some OR cases to ASCs, they often pursue two primary strategies. First, they continue acquiring physician practices, although many physicians are reluctant to work for health systems. Second, hospitals develop ASCs as recruitment and retention tools for their employed physicians.
A critical aspect of this strategy is allowing surgeons to have ownership stakes in ASCs. Some hospital systems permit full-time employed physicians to invest in joint ventures, which can strengthen their alignment and engagement. Others, however, do not offer ownership opportunities, which limits the effectiveness of these partnerships. Moving forward, hospital systems must evolve their ASC strategies to remain competitive and attract top surgical talent.
Q: What are the downsides of not allowing physicians to buy into ASCs?
DD: When physicians lack financial investment in an ASC, there’s less incentive for them to utilize that facility. ASCs are designed for efficiency and cost-effectiveness, with standardized equipment, materials, and staffing. For example, turnovers in ASCs are handled by a dedicated nurse and tech for the room, ensuring smooth operations.
In contrast, hospitals often allow surgeons to use any equipment or implants they prefer, without stringent oversight of operational costs. Without ownership, surgeons may gravitate toward facilities where their preferences are prioritized, reducing ASC utilization.
One caveat to this, however, is when an ASC is 100% utilized by employed physicians and the hospital is the driving force for ASC utilization to make room for higher-acuity cases within their ORs. These models work well, and the health systems are generally reacting to external pressures such as evolving payer policies.
