Growing Your ASC, the Path of Least Resistance: Top 4 Easiest Specialties to Transition Into an ASC

When looking to grow the number of cases in your ASC and enhance revenue, the size of a physician's practice along with the skill and efficiency of the surgeon are important factors to consider. However, if we look at a group of physicians from a variety of disciplines and assume they all busy, cost effective and talented, certain specialties will lend themselves better to life in the ASC. This is not big news, but what is interesting is the examination of the conversion rate from the hospital into the outpatient setting for the different specialties. If you are running an efficient ASC it is easy to illustrate the benefits of your center to a potential recruit. Faster turnaround times, lower complication rates, higher patient satisfaction and lower infection rates are just a few of the advantages that exist when compared to the hospital. Why then do certain specialties seem more reluctant to embrace life in the ASC?

This article will illustrate some of the obstacles and highlight those physicians who have proven to be the most enthusiastic adaptors. If your goal is to dramatically ramp up your case volume, the following specialties and subspecialties are the ones to target first.

When adding a new physician to your ASC, it is important to mitigate the risk to the existing partnership. This should be a business transaction with the end goal of creating a more stable, robust and profitable center. A trial period for a new recruit protects both the partnership and the new physician. It allows both parties to synchronize clinically as well as to analyze the financial ramifications. The ideal scenario involves recruiting a surgeon in a specialty already represented in your center. Not only do you already have the equipment to accommodate him/her, but your staff is familiar with the procedures being performed. However, when adding a new specialty, purchasing new equipment can be expensive. When shopping for more expensive pieces of equipment, it is always best to investigate renting or leasing first. In many instances, reps will be willing to let your center "trial" a piece of equipment for a number of weeks while you decide what makes the most clinical and financial sense.

Once your center is properly equipped and staffed, a deeper examination of the specialties represented in outpatient surgery centers reveals that some are easier to recruit than others. They can be broken down into one of three categories: Big Money Makers, Nice Additions and Easy Adaptors.

Big Money Makers    
The first category (Big Money Makers) is comprised of orthopedic, spine and bariatric surgeons. The case mix generally consists of higher acuity procedures and, especially in an out-of-network environment, the reimbursements can be quite substantial. Case mix and high reimbursements are the two main reasons that their bonds with the hospital are not easily broken. The perceived political ramifications, along with the number of cases that must remain in the hospital for clinical reasons makes it impossible for them to divorce themselves completely from this relationship. In fact, any one of these surgeons with great intentions of bringing all of his/her outpatient cases to the center has a tendency to fall short of their commitment. The convenience of slipping simple cases in between larger inpatient cases to cut down on travel, fear of losing block-time, and the use of expensive implants are common excuses for continued hospital use for outpatient cases.

Nice Additions
The middle category consists of physicians who do a fair amount of outpatient surgery but neither their volume nor their average reimbursements make them highly coveted. It's for these very reasons that this group of "Nice Additions" often plays second fiddle in the hospital. Consequently, it is not uncommon for these podiatrists, urologists, and GYN surgeons to embrace your ASC simply for the purpose of obtaining better OR times. They can be quite grateful when the red carpet is finally rolled out for them. From an operational standpoint, the capital outlay for their equipment is relatively small when compared to some of the other specialties and there can be quite a bit of overlap if you are already doing general surgery or orthopedic cases. The biggest area of caution with this group however, potentially contributing to lower case volume, is the number of procedures that can be performed in an office setting. Even though Medicare approves a certain procedure to be done in the ASC, if the physician's office is properly equipped, the site-of-service differential combined with the convenience will often be enough to keep that patient in the office.

Easy Adaptors
The final category is Easy Adaptors, and not coincidentally, this group of four specialties yields the highest number of patients. While relative reimbursements tend to be lower, the revenue they generate is made up by sheer volume. For this reason your staff must be at the top of their game and be able to turn over a room in less than 10 minutes. Being able to take three days of surgery and compress it into two is an extremely valuable incentive for your center to offer a member of this category of Easy Adaptors.

In ascending order, the #4 specialty for easy adaptation is ENT. A majority of their cases can be done in an outpatient setting, and especially when treating children, the ASC can be much less intimidating than the atmosphere in the hospital. Along these lines, it is important to be flexible and accommodating with an ENT physician. Make sure you are not losing to the hospital any cases that must be seen promptly because the patient can't wait until the doctors next free block at the center. The ability to be agile and creative is a major advantage of the ASC. Be sure to leverage it.

Pain management    
#3 is pain management. Similar to Urology, it is important to make sure that a majority of cases will come to the center and not stay in the office. However, the volume of an average physiatrist or pain specialist, combined with the low supply costs, makes him/her an excellent candidate. Recruiting pain management into a center that already does orthopedics or spine can also create a symbiotic relationship that benefits both practices.

GI and ophthalmology
The top spot for the smoothest transition into an ASC can be debated between two groups. Gastroenterologists perform the highest annual number of procedures in multi-specialty ASCs and ophthalmology is represented at the greatest number of centers (according to SDI's 2008 Outpatient Surgery Center Market Report). The determination for smoothest transition may also depend on the physical make-up of your ASC and the current physician groups working there. GI can be done in a smaller space, but it's easier to clean and flip an OR being used for cataract surgery. Ultimately, the ease of recruitment, and the speed the surgeons have proven they can ramp up their cases in a new ASC, reveals the winner. When evaluated through this lens … the ophthalmologists are the easiest to convert. They simply relay to their scheduler where they now wish to perform their surgery, walk out of the hospital, never looking back. It is a perfect marriage and their commitment to the center is instantly realized.

Mr. Merrill ( is a vice president of business development for Ambulatory Surgical Centers of America. Learn more about ASCOA.

Read more guidance from ASCOA:

- 5 Ways ASCs Lose Money

Decline in Payments Posted: Q&A With Dr. Brent Lambert of ASCOA

4 Reasons You Need a Minority Partner

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