3 gastroenterologists' secrets to successful ASC ownership

As burnout, consolidation and workforce shortages continue to wreak havoc on healthcare, successful management strategies may be the key to maintaining growth, staffing and profit as the industry continues to evolve. 

Three gastroenterologists connected with Becker's to share their secrets to successful ASC management amid ongoing changes in the industry.

Question: What would you put on a "successful ASC management" cheat sheet?

Note: Responses have been lightly edited for length and clarity.

George Dickstein, MD. Gastroenterologist at Boston Endoscopy Center and Chair of the Department of Medicine at MetroWest Medical Center (Natick, Mass.): 

1. Staff appropriately now and for the future; the medical workforce changed seemingly overnight. Extended days and weekend shifts, even at time and a half, no longer appeal to many employees. Successful center HR management requires renewed attention to recruitment and retention of nurses and techs, understanding what keeps them happy at work (beyond competitive wages) and working collaboratively to achieve those goals. This may be one area where accepting a higher cost structure really pays dividends in the long term.

2. Assure fair facility fee compensation for the services provided. This will take a dynamic understanding by center leadership of the commercial and government payer base, including burgeoning Medicare Advantage plans. Getting accurate rate information to know what your competition is collecting can be challenging but will often be worth the investment. As dollars tighten and costs increase, and insurers try to shift procedures to non-hospital licensed sites of care, there are inevitable conflicts and bumps in the road that will sometimes require difficult decisions to be made, including deciding what plans NOT to participate in. Resist the temptation to participate in poorly paying plans, especially when such participation will have little real impact on your success.

3. Secure sufficient anesthesia staffing — the anesthesia staffing shortages are not easily solved, particularly as reimbursement shrinks in many markets. Many ASCs are swallowing the bitter pill that they now have to supplement anesthesia pay with stipends or guaranteed day rates to keep sufficient staff. Discord between scope of practice among CRNAs and MDs does not help the matter. However, there are major staff shortages even in states where the working relationship between MDs and CRNAs is very good.

4. Be on the constant lookout for opportunities for additional volume growth. Sometimes this makes for strange bedfellows, like learning to work with, not against, your local hospital, or learning to work with your competition to be better aligned as a community of providers dedicated to keeping independent physician providers and the center financially secure.

5. Manage costs aggressively. Look for group purchasing organizations and do not be shy about pitting one against the other. Do not accept someone's claim that their prices are best without actually confirming it. Critically look at your inventory and concentrate on using lower-cost supplies, especially when they have little impact on patient care or outcomes, even when the providers might prefer one peripheral or device over another.

Mark Mattar, MD. Director of the IBD Center and Quality Improvement Officer of the Department of Gastroenterology at MedStar Georgetown University Hospital (Washington, D.C.):

My secret to success stems from the framework of transformational servant leadership. Leading in a successful GI practice in a health system as we come out of a pandemic brings its own special challenges. At the end of the day, we focus on the people. We prioritize patient care without compromising associate wellness. We work as a team to evaluate each provider's needs and how we can help them work towards our common mission. This isn't easy, but when you pay attention to the needs of the team and act on them, we all succeed.

Arun Swaminath, MD. Chief of Gastroenterology at Lenox Hill Hospital (New York City): As we've opened a wonderful new ASC/endoscopy center at Lenox Hill Greenwich Village, this question has been central to our mission.

Two guiding principles: prioritize patients [and] prioritize physicians.

Operationally, for patients this meant we chose a central area convenient for travel,  quick appointments, efficient scheduling, excellent arrival/recovery space, and doctors who are specialists in their fields.

For the physicians, new top-line equipment (the latest endoscope models), a spacious suite in which our procedures can be performed (a true luxury in Manhattan) and a dedicated and well-trained team of anesthesiologists, nurses and techs that align in our mission.

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