As consolidation accelerates, regulations tighten and financial pressures mount, ASC leaders are rethinking how ownership structures can support long-term sustainability.
Four ASC leaders joined Becker’s to discuss what immediate change they would make to today’s ownership landscape, and why it matters for the future of the industry.
Question: If you could make one immediate change to the current landscape of ASC ownership, what would it be — and why?
Editor’s note: These responses were edited lightly for clarity and length.
Alejandro Badia, MD. Orthopedic Surgeon and Founder of OrthoNOW (Miami): ASCs must gradually achieve parity in payment from insurance carriers when compared to the equivalent surgery in a hospital. Data already shows that many procedures actually have better outcomes with less complications (which cost more money) than comparable cases performed in the hospital environment. There are many clear reasons for this, but unless we see insurance carriers, referral sources, employers and society in general embrace lower cost healthcare solutions, such as ASCs, we will see US healthcare expenditure surpass the 20% GDP mark.
Greg DeConciliis. Administrator of Boston Out-Patient Surgical Suites: I think ownership should be commensurate with productivity. Obviously federal law prohibits this in healthcare, although this is not the case with every other business entity. Ownership should be aligned with how much value you bring to a business. In the surgical world, certain surgeons are busier than others, whether due to efficiency, reputation or pure speed in the OR. However, their increased volume doesn’t allow them to reap more benefits on the profitability side. Although they are directly contributing to increased overall margin, they have to have similar ownership percentages to the slowest and/or most expensive surgeon. It’s not a fair business practice, and unfortunately it doesn’t seem that federal law will ever allow these regulations to relax. As an Administrator, surgeons become frustrated and it creates tremendous animosity and partners meetings, etc.
Larry Sobal. CEO of Heart and Vascular Institute of Wisconsin (Appleton): Change the rules so that physician practices, including non-procedure physicians (such as cardiology) can have group ownership of the ASC without falling outside of the Anti-Kickback Safe Harbor. This would allow non-invasive cardiologists, who see a lot of patients in clinic and refer some to their interventional or EP colleagues for possible procedures, can benefit from the proceeds of the ASC.
Rebecca Anne Vitillo, BSN, RN. Administrator at Meadows Surgery Center (Nutley, N.J.): As far as the first question is concerned regarding ownership, in order to maintain independence, autonomy and eradicate bureaucratic control and so many levels of leadership I would immediately return to being a solo ASC as opposed to being part of a large conglomerate.
