Columbus Eye Center Achieves Long-term Success; A Shortage of Individual ASCs for Sale Drives Prices Higher; City of Joliet Challenges Relocation by Silver Cross Hospital

The Columbus Eye Surgery Center (Columbus, Ohio) opened "the very month Bill Clinton and Congress deadlocked on the budget, and the government shut down -- so we could get no one from Medicare to certify our center," says Richard G. Orlando, MD, FACS, the president of Columbus Ophthalmology Associates. "Even with that [setback], we knew we had done the right thing." Within two months, the four-man practice had moved most of its core procedures to the center.

"Twelve years later, we have paid off all our original debt," says Dr. Orlando. "We have added three other docs and now do 4,000 case per year. And we never had a corporate or hospital partner. So it can be done."

Here are the keys to Columbus Eye Surgery Center's success.

CON due diligence. The certificate of need laws in Ohio were so stringent that even a hospital could not just open an ASC without it going through the proper channels for approval. The group hired a lawyer who usually worked on behalf of hospitals that wanted to add beds or open their own outpatient facilities in order to guide them through the six-month, $50,000 proposition.

"It was indeed a landmark decision to fight the CON laws in Ohio, to even think that a group of surgeons would have the courage to open an ASC," says Dr. Orlando. "We [chose to pursue a location] on the east side of Columbus, on the campus of Mt. Carmel East Hospital, which had only three full-time eye surgeons on staff, none of whom did phacoemulsification, retinal or glaucoma surgery,"

By choosing a location not saturated with ophthalmologists, the physicians group was able to prove that the number of cases the four surgeons performed on a yearly basis "would have overwhelmed the hospital, as it had neither the equipment nor the staff to serve our needs," says Dr. Orlando "We worked out an agreement to build the ASC in a medical building that was going up on the hospital grounds at that time. In essence, they would be adding services unavailable to the growing east side of town right on their campus just 200 yards from their ER.

"So they helped us obtain CON approval, and we were set to build the first physician-owned ASC in Ohio."

Seeking successful models. "During the CON process, I visited several eye only ASC's across the country to get ideas on how to make our operation lean, efficient and patient-friendly," says Dr. Orlando. Ideas the Columbus Eye Surgery Center ended up incorporating included

a separate viewing room for patients' families to view the actual procedure;

having a staff member in the viewing room to narrate the procedures for the families;

having patients wear street clothes in the OR;

buying a special eye surgery cart that kept the patient from having to be moved from one bed, to the OR, to an OR table and back to a recovery bed;

having pre- and post-op patients alike in a common large room with a centralized nurses station, so that nurses could float between both areas as needed; and

a single anesthesiologist who oversaw the entire area while also administering pre-op peribulbar injections and sedation, and starting all IVs, so surgeons could work between two ORs without interruption to give medications.

Innovative procedures. "Retinal surgery was usually an overnight hospital stay back in 1996, but [Robert A. Bruce, MD,] developed his technique to the point that he was the first retinal surgeon to do vitrectomies and detachments as an outpatient in Ohio," says Dr. Orlando. "His skills were such that he could complete these procedures in less than 40 minutes. This was an important milestone and innovation, though it's now common throughout the United States."

In addition, Robin Beran, MD, a corneal refractive surgeon, had been performing RK since 1990, "long before anyone considered doing it as a subspecialty," says Dr. Orlando. "We began doing RK and later on PRK/LASIK based on his experience. As you may know, these patients are a little different than the regular ophthalmology patient and demand the utmost in customer service. This helped us when we put together the ASC, as we had six years' experience and good word of mouth from our refractive practice."

Strong bank partnership. "KeyBank, our business banker, looked at our business plan and took the plunge with us even though no privately owned ASC had ever been attempted before," says Dr. Orlando. "The bank depended on our skills as surgeons to make the ASC work and we depended on it to help get us the ASC we needed."

The faith of all involved was tested immediately, however, when the national budget shutdown occurred, and there was "no funding for any projects or departments -- including to Medicare for new ASC licensing," says Dr. Orlando. "That meant no federal inspector could come to our center, look over our test cases, review our facility nor grant us approval to do surgery."

And the Columbus Eye Surgery Center had just hired four nurses, a full-time administrator, a full-time billing person, as well as a front office clerk and support staff.

"We could do no surgery, at least none that would be paid for," he says. "We now had a decision to make and we needed the bank's support. We chose to pay these hand-chosen staff members, do minor surgery that would be covered, but needed a 'bridge' loan to cover these costs."

It would be four months before the facility could begin the Medicare certification process and another four before it received any payments, due to further problems with Medicare's giving the center a provider number.

"KeyBank again stepped up with a $250,000 bridge loan to keep the staff we had, order supplies and keep the center open," says Dr. Orlando. "We all stuck to our original plan of keeping the center an eye only facility despite having calls from pain specialists, podiatrists, and some general surgeons about opening it up to them. We could have paid off that bridge loan sooner but felt we would not benefit in the long run so we stuck to our original goal."

Since the rough early days, the center has grown each year, adding more procedures and more surgeons. The most recent milestone in its successful story is the paying off of all loans -- the Columbus Eye Surgery Center is now debt-free and continues to thrive, despite the departure (due to retirement) of Dr. Bruce.

"As the next generation of surgeons is added to the center, it is my goal to continue to provide our patients with the latest technology, the best qualified surgeons and the most compassionate staff possible," says Dr. Orlando.

From:	Becker Scott <becker@beckersasc.com>
Subject:	Columbus Eye Center Achieves Long-term Success; A Shortage of Individual ASCs for Sale Drives Prices Higher; City of Joliet Challenges Relocation by Silver Cross Hospital
Reply:	becker@beckersasc.com