From: Becker Scott <>
Subject: [Becker's ASC E-Newsletter] Five Interesting Developments in First Quarter of 08; 10 New Stories Briefed Here and Posted at; 6 Days Left to Save $100 on Early Registration; 15 Great Companies
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April 24, 2008
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Five Interesting Developments in First Quarter of '08

This has been a fascinating first quarter of 2008. Five of the developments that we find to be really interesting are as follows:

1. The acceleration of high deductible plans and consumer-driven healthcare. Commentators speak in abstract terms about "consumer-driven healthcare." The real concept is that people will pay a greater proportion of their healthcare costs and thus become more concerned about shopping for services based on cost and quality. Quietly, and without a lot of fanfare, we are seeing a great increase in the amount of high deductible plans and high co-payment plans, with issues surrounding them finding their ways into California courts, the desks of presidential candidates and recently receiving greater coverage from the mainstream media, including the U.S. News & World Report and New York Times.

This increase has the effect of having people be much more concerned and much more often a consumer of healthcare rather than someone that just accepts services at a place their physician determines. From an ambulatory surgical center perspective, this means much more working with patients on a case-by-case basis to assess whether the rates should be negotiated for a specific patient. This is something that is often achievable even though it has to be done in the context of other rules relating to commercial payor plans, Medicare and Medicaid.

2. Healthcare jobs out stripping manufacturing jobs for the first time. The country, for the first time, is seeing overall healthcare jobs outstretch the number of manufacturing jobs. Healthcare jobs are being recognized as engines of growth and not just a cost to be borne. This reminds of a comment made by the Chief Executive Officer of GE, Jeff Immett at a conference a few years ago. There he stated, in so many words, all is well at GE as long as our revenues from healthcare and our profits from healthcare outstrip our rising healthcare costs. This country, at some point, instead of viewing healthcare solely as a problem should see it as the driver of economics and jobs that it is. Often healthcare provides high quality service jobs not readily available in other parts of the economy. See Wall Street Journal Article "Factories Fading, Hospitals Step In" (subscription required) and view March statistics from the Bureau of Labor Statistics by clicking here.

3. Multiples for ambulatory surgical centers remain high. You can view a short summary of a survey done by Healthcare Appraisers by clicking here. This survey shows that, notwithstanding challenges to the economy, multiples for ambulatory surgical centers remain high. The survey results rings true with the several ambulatory surgical center transactions that we have been involved in either closing or helping solicit offers for in the last few months. The prices remain high and there remains a good deal of purchasers for many ambulatory surgical centers. To read an article we provided last year which discusses pricing by tier in the ASC Market, click here.

4. Hospital closures. There has been increased discussion and talk of hospital closures recently, including hospitals in San Francisco, Washington and New York. For those who follow the physician ownership debate as to whether or not physicians should be allowed to own surgery centers or hospitals, it is fascinating to see that one of the most noted hospital closings, SSM Health Care's St. Francis Hospital and Health Center in Blue Island, Ill., is set to occur in a place where there are no physician-owned hospitals within 30 to 40 miles of the hospital and few ambulatory surgical centers. This highlights the facts that there are two different issues that have to be wrestled with. First, the country needs safety net hospitals for patients. Second, accomplishing that goal should not be at the expense of improving initiative, technology and developments in healthcare. Surgery centers and physician-owned hospitals offer so many benefits that to erase these benefits based on the safety net argument an issue that really is a totally different issue, is arguably ludicrous.

5. Massachusetts healthcare plan. The Massachusetts Plan is an innovative plan based on the premise that everybody in the state is required to have healthcare insurance. There, they did a significant study and found that essentially the uninsured could be divided into three main categories. Those who are in their 20's and 30's and could afford healthcare but choose not to buy it (the true freeloaders), those that were poor but not so poor as to be eligible for Medicaid, and those that were eligible for Medicaid but did not sign up for it. After two years of the experiment, the results are starting to show. The plan is a little bit more costly than expected (but not nearly to the magnitude of the unexpected costs of the Medicare Drug Bill a few years ago) and it is helping to solve a problem. Fascinating, it comes from a bipartisan effort in relatively liberal state that was driven by a Republican governor.

BE Smith 4x consec start 401
Six Days Left to Take Advantage of Early Registration for June Orthopedics Driven ASC Conference 

The 6th Annual Orthopedics, Pain Management and Spine Driven ASC Conference: Improving Profits, Legal and Business Issues, to be held June 19 to 21 in Chicago, is a chance to network with 500 owners, surgeons, administrators, exhibitors and speakers. Register before May 1 and you will save $100.

More than 70 speakers will present talks focused on strategic, practical, business and legal topics for ASCs.

Here are 17 of the terrific speakers you can hear:

  1. Dr. Brian Cole, one of the country's most renowned orthopedic surgeons who specializes in cartilage restoration, will speak on the clinical future of orthopedics.

  2. Tucker Carlson, the well-known political commentator on MSNBC, will speak on the intersection of healthcare and politics.

  3. Dr. Tom Price, an orthopedic surgeon and congressman, will address the audience Saturday morning and provide some of his thoughts regarding the future of healthcare.

  4. Dr. James Caillouette, founder of a very successful ASC (Newport Orthopedic Institute), will speak on handling cases, such as total joint replacements, in ASCs.

  5. Dr. James Lynch, an extremely smart and gifted neurosurgeon, will discuss spine surgery in ASCs.

  6. Dr. Brent Lambert, a leading national physician and developer and owner of ASCs and founder of ASCOA, will speak on turning around ASCs.

  7. Mike Snow, former CEO of Surgical Care Affiliates, will speak on trends in the broad ASC market and how they impact individual ASCs and planning.

  8. I. Naya Kehayes, MPH, founder of Eveia Health Consulting & Management, is a leader in her field and will speak on managed care contracting.

  9. Dr. John Caruso, president of the Parkway Neuroscience & Spine Institute and a leader in neuro-spine, will discuss spine procedures and handling complex cases in ASCs.

  10. Caryl Serbin, the founder of Surgery Consultants of America and Serbin Surgery Center Billing, will speak on billing and coding for ASCs in light of the new Medicare system.

  11. Dr. Tom Lorish, medical director at the highly respected not-for-profit Providence Health System, and Miriam Odermann, administrator of ambulatory services at Providence Health System, will speak on ASC joint ventures.

  12. Tom Yerden, founder of Aspen Healthcare and now founder and CEO of TRY Health Care Solutions, will speak on physician-hospital joint ventures.

  13. Tom Mallon, CEO and founder of Regent Surgical Health, a buyer, developer and manager of outpatient surgery centers and physician-owned hospitals, will discuss how to incorporate orthopedics, spine and pain management into an ASC and how to build an ASC around these specialties.

  14. Bill Southwick, President and CEO of HealthMark Partners, an ASC development company, will discuss revitalizing an ASC and tips to improve an ASC immediately.

  15. Dr. Scott Glaser, a physician at Pain Specialists of Greater Chicago who provides comprehensive, multidisciplinary, and minimally invasive treatment of pain, will discuss a clinical and business view of pain management in ASCs.

  16. Dr. Jack Jensen, a board-certified orthopedic surgeon and medical director of Athletic Orthopedics & Knee Center who has worked at the Goodwill Games & Olympics, will discuss how to maintain successful physician investor relationships over long periods of time.

  17. Jon O'Sullivan, a senior principal and founding member of VMG Health, a valuation and transaction advisor, will discuss how to use benchmarking to measure and enhance an ASCs value.
Download the complete program agenda and event brochure here. CME, CEU and CASC credits available. Paid subscribers to the Becker's ASC Review can receive a $100 discount. Additional discounts apply when registering two or more attendees. We've now added 30 more hotel rooms a night to our block to accommodate interest.

There are four easy ways to register:

  • Online. Register through our secure Web site.

  • Fax. Complete the order form and fax it to (312) 706-2526. Please show ASC Communications c/o a5 as the subject line.

  • Mail. Complete the order form and mail it to ASC Communications; c/o a5 Inc.; 1 N. LaSalle Street, 47th Floor; Chicago IL 60602.

  • Phone. Call (312) 546-6042 to register.

Just a few exhibit spots remain. If you are interested in exhibiting, contact Jessica Cole, Dan Bragaw, Emily Noyes or Matt Leemkuil.

Surgical Notes 401 Start 17x
New Orleans Hospital Agrees to Pay $1.75 Million to Settle False Claims Allegations; Language Banning Physician Hospitals Slipped Into Farm Bill; Medicare, Medicaid Fraud Self-Disclosure Protocol Tightening; CMS Issues Quarterly Update to ASC Payment System;  Syngergetics USA Sues Alcon

1. New Orleans Hospital Agrees to Pay $1.75 Million to Settle False Claims Allegations. A New Orleans Hospital, Touro Infirmary, will pay $1.75 million to settle allegations that it submitted false Medicare claims, according to the Department of Justice (DOJ). Go here for complete story.

2. Language Banning Physician Hospitals Slipped Into Farm Bill. In the latest attack on physician-owned specialty hospitals, opponents of the surgical facilities have sneaked provisions into the farm bill after versions of the legislation had been approved by both the House and Senate. Get the full story here.

3. Medicare, Medicaid Fraud Self-Disclosure Protocol Tightening. New requirements of initial self-disclosure of Medicare or Medicaid fraud have been issued by the Department of Health and Human Services Inspector General Daniel Levinson in an open letter. The fuller disclosure to the Office of Inspector General will be required if providers want to win the leniency provided for by the self-disclosure protocol. For the complete story, click here.

4. CMS Issues Quarterly Update to ASC Payment System. CMS has issued updated payment rates for selected separately payable drugs and biologicals and provided rates and descriptors for newly created Level II HCPCS codes for drugs and biologicals in its first quarterly update to the ASC payment system. Click here for the story.

5. Syngergetics USA Sues Alcon Over Vitrectomy Equipment Sales Practices. Claiming it has lost tens of millions of dollars due to Alcon's alleged unfair practices, Synergetics USA, a leading microsurgical device company, has filed a civil, antitrust lawsuit in the United States District Court for the Southern District of New York (docket number 08-CV-3669) against Swiss-based Alcon and its primary operating subsidiary in the United States, Alcon Laboratories. Synergetics is seeking a recovery that it believes could exceed $100 million. Read the complete story here.

Spring Group 2nd/4th through July
4 Quality Benchmarks for ASCs; Venture Will Limit Choice; Nevada Lawmakers To Push Mandatory Accreditation for ASCs Following Hepatitis Cases; Summit Partners Provides Equity Investment to Anesthetix; Understanding Outsourced Anesthesia

1. 4 Quality Benchmarks for ASCs. The Colorado Ambulatory Surgery Center Association (CASCA) released the results of the nation's first Quality Research Initiative stat survey of ASC activities, including procedures performed, nurse to patient ratios, infection rates and patient satisfaction. Click here for complete story.

2. In the News: Venture Will Limit Choice.
In an op-ed in the Argus Leader (Sioux Falls, S.D.), R. Blake Curd, MD, a clinical assistant professor with the University of South Dakota School of Medicine and director of Physician Hospitals of America, hits out at a proposed joint-ventured ASC between Avera McKennan Hospital and University Health Center in Sioux Falls. For full story, click here.

3. Nevada Lawmakers To Push Mandatory Accreditation for ASCs Following Hepatitis Cases. Several lawmakers in Nevada plan to introduce legislation which would require ASCs to be accredited or inspected by an organization other than the state's Bureau of Licensure and Certification, according to published reports. To read the full story, click here.

4. Summit Partners Provides Equity Investment to Anesthetix. Anesthetix Management, a provider of hospital-based anesthesiology and pain management services to hospitals and ambulatory surgery centers, has accepted a minority equity investment from Summit Partners, a private equity and venture capital firm experienced in growing healthcare companies. For the complete story, click here.

5. Understanding Outsourced Anesthesia. Marc Koch, MD, MBA, the CEO of Somnia, sat down with Becker's ASC Review and discussed outsourcing anesthesia. To read Dr. Koch's insight, click here.

You can visit our E-newsletter archive here, our redesigned white papers archive here, and our articles archive here.
ASC Society
CASCA meeting features Scott Becker; Bruce Bright earns CCIM distinction; Jeff Gonyo founds Geneva Glen Capital; Seeking three proctors to attend June conference for free; Share your insight with us

1. CASCA meeting attracts more than 200 people. The Colorado Ambulatory Surgery Center Association (CASCA) held its spring conference last week and saw more than 200 people attend. Scott Becker was privileged to serve as the keynote speaker at this outstanding gathering. Thank you to CASCA, its leadership and Simon Schwartz.

2. Congratulations to Lt. Col. Bruce Bright. Bruce Bright, director of business development for The Sanders Trust, has become a certified commercial investment manager (CCIM), a title held by only 6 percent of commercial real estate practitioners nationally.

3. Jeff Gonyo founds Geneva Glen Capital. Jeff Gonyo, former managing director for private equity investment firm Wind Point Partners, has founded Geneva Glen Capital, which is focused on acquiring smaller to lower middle market companies, i.e., below $100M in enterprise value. The criteria for investment are:

  • U.S. or Canada based
  • Growing or stable (no-growth) businesses
  • Either change of control transactions or minority growth equity investments/shareholder buyouts
  • Able to facilitate company leadership transitions if required
  • Minimum EBITDA of $1 million
  • Industries of preference include:
    • Healthcare-services, distribution and lower-tech products
    • Business and Consumer Services
    • Consumer Products
    • Niche Industrial Manufacturing
    • Value-add Distribution
    • NOT interested in high technology, retail, restaurants, real estate, or start-ups
For more information about Geneva Glen Capital, call Jeff Gonyo at (312) 225-4820 or e-mail him at

Seeking three proctors to attend June conference for free. We are seeking three people to attend the June Orthopedics-Driven Conference free of charge (an $875 value). You must be administrators or surgeons and must be paid subscribers to the Becker's ASC Review. Each person will each be required to proctor fully 20 sessions each and provide a detailed review of the quality of the presentations. They must not have done this before for ASC Communications. We need detailed feedback to help ensure the quality of our speakers. Please e-mail Scott Becker if you'd like to be considered for this role.

5. Tell us what you want to learn about. We need your help! We are working to determine future topics for audio conferences and for seminars at our October Improving the Profitability of and Establishing ASCs -- Business and Legal Issues Conference in Chicago and want to know what you want to learn about. Please take a few minutes to take the survey. Your input helps us ensure we are better meeting your needs with these resources. Thank you for your time and assistance.

TY--MedHQ 5x
Thank You to 15 Leading ASC Review Sponsors
This week we want to thank and highlight the following advertisers, exhibitors and sponsors who have supported the Becker's ASC Review extensively. 

1. VMG Health. VMG Health is recognized by leading healthcare providers as one of the most trusted valuation and transaction advisors in the United States; whether circumstances call for a comprehensive valuation, the sale or acquisition of a facility, or joint-venture development assistance, VMG Health offers a unique and in-depth understanding of the relationships, requirements and business issues that surround today's healthcare facilities. For more information about VMG, click here.

2. Surgery Consultants of America and Serbin Surgery Center Billing. Surgery Consultants of America (SCA) provides a comprehensive scope of services including turn-key ambulatory surgery center design, development, and management. Serbin Surgery Center Billing (SCB) concentrates on the unique needs of surgery centers and provides expert and accurate coding, billing, collections, and managed care negotiations solely to the ASC industry. To learn more about SCA, click here; to learn more about SCB, click here.

3. Symbion Healthcare. Symbion is a leading provider of high quality surgical services across many specialties; led by one of the industry's most experienced management teams, the company was founded in 1996 to acquire, develop and operate surgical facilities in partnership with physicians, hospitals and health systems. For more information, click here.

4. Surgical Notes. Surgical Notes is a nationwide provider of medical transcription, coding and other related value-added information technology services for ASCs. It is led by the driven and smart Jeff Blankenship. For a complete profile, go here.

5. Meridian Surgical Partners. Meridian, led by Kenny Hancock and Buddy Bacon, acquires interests in established physician-owned surgical facilities, as well as, partners with physicians seeking to grow their businesses locally through the development of new surgical facilities. To learn more about Meridian, click here.

6. Marshall Erdman. As an integrated provider, Marshall Erdman & Associates offers service from facility conception to completion, including advance planning, development, design and construction. Erdman is an exceptional firm. For more information about Erdman, click here.

7. QSE Technologies. QSE Technologies is a premiere IT systems integrator serving the ambulatory healthcare industry for more than five years; QSE manages all aspects of IT infrastructure design, configuration, installation and ongoing tech support for new and existing ASCs nationwide. For a more complete profile, click here.

8. HealthCare Appraisers. HealthCare Appraisers is a nationally recognized valuation and consulting firm providing services exclusively to the healthcare industry, including fair market value opinions for compensation and service arrangements, business valuation, consulting and advisory services and litigation support. To learn more, click here.

9. Amkai. Amkai is an outstanding software company with 20-plus years of experience delivering administrative and clinical solutions to ASCs, surgical hospitals and physician practices. For more information, click here.

10. SourceMedical Solutions. SourceMedical, which acquired Scott Palmer's company Prescient Healthcare Systems, is the leading provider of outpatient information solutions and services, collectively serving ASCs, rehabilitation clinics and diagnostic imaging centers. For more information, click here.

11. National Surgical Care. National Surgical Care (NSC), a nationwide owner and operator of ambulatory surgical centers, focuses on addressing the needs and problems confronting surgery centers across the country; NSC's experienced management team offers a high degree of knowledge, skill, understanding and strategic resources for its centers. To learn more about NSC, click here.

12. Prexus Health. Prexus Health, led by Dr. Ajay Mangal and Don Jansen, is a 100 percent physician-owned company that specializes in the development and management of multi-specialty, physician-owned ASCs and small hospitals. To learn about Prexus Health, click here.

13. Pinnacle III. Pinnacle III specializes in the operational development, management, select management, and billing for ASCs; whether you are a physician group, hospital or hospital joint-venture, Pinnacle III delivers proven success in both single and multi- specialty ASCs throughout the country. For more information about Pinnacle III, click here.

14. CIT Healthcare. CIT Healthcare offers a full spectrum of financing solutions and related advisory services to companies across the healthcare industry; through its client-focused and industry-centric model, CIT Healthcare effectively leverages CIT's extensive knowledge and understanding of the healthcare marketplace and approximately $80 billion "A" rated balance sheet. To learn more about CIT Healthcare, click here.

15. CareCredit: Patient Payment Plans. CareCredit lets patients pay their current bills in full immediately with the use of convenient monthly payments; your center gets paid in two business days with no responsibility if the patient delays or defaults. Find out more about CareCredit by clicking here.

For more information and to access a longer list of valuable ASC resources, go here.

Six Upcoming Events and Features

We have six exciting events and features that are upcoming.

1. Orthopedic Driven ASC Conference. This conference will be held June 19 to 21 in Chicago. We expect 450 to 500 outstanding people.

2. July/August Issue of the ASC Review. This issue will feature 60 people to know in the ASC industry as well as focus on ophthalmology, urology and ENT for ambulatory surgical centers.  We are increasing the number of issues we publish next year to include three added special issues.

  1. Mergers and acquisitions of ASCS
  2. Legal, regulatory and safe harbor issues
  3. Valuation and benchmarking issues
To see the entire '09 editorial calendar, please e-mail Scott Becker at

3. The Hospital Review. We are providing an issue this fall of The Hospital Review: Business and Legal Issues for Hospitals. This will be a quarterly publication next year. To see the editorial calendar, please e-mail Scott Becker at

4. May Teleconference on Managed Care Contracting for ASCs. An audio conference focused on Managed Care Contracting for Ambulatory Surgical Centers. The conference is highlighting two of the best managed care negotiators and speakers in the country. This will feature I. Naya Kehayes, MPH, the CEO of Eveia Health Consulting and Management and Caryl Serbin, RN, BSN, LHRM, the CEO of Surgery Center Billing.For information on this conference or to register, click here. This event will take place on May 8.

5. June Teleconference on Orthopedic Coding for ASCs. We have a conference featuring Stephanie Ellis, RN, CPC, on Orthopedic Coding for Ambulatory Surgical Centers. Ms. Ellis is a leading expert on coding for ASCs and for physician specialties. She will present a 75-minute teleconference on this issue on June 11. For information and to register, click here.

6. October ASC Conference. Our 15th Annual ASC Conference held in conjunction with the ASC Association. This event will be Oct. 23 to 25, 2008. We expect an outstanding crowd. To download the prospectus, click here.

Becker's ASC Review Subscriber Benefits

If you are a Becker's ASC Review paid subscriber, you are entitled to the following new benefits:

  1. Discounts on the cost of audio conference and Webinar registrations.

  2. $100 off registration for both main and pre-conference sessions at the June conference.

  3. $50 off registration for both main and pre-conference sessions at the October conference.

  4. Free copy of the VMG Health Intellimarker benchmarking survey, an extremely valuable guide.

To subscribe to the Becker's ASC Review go to

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