Starting From Scratch: Top 5 Tips on ASC Development From Manhattan Endoscopy Center

The Manhattan Endoscopy Center in New York City opened in December 2011 and is one of the largest single-specialty GI centers in the nation, with 15,000 patients expected in the first year. The center currently has 17 active physicians, and the facility is a completely renovated state-of-the-art space on the 5th floor of a historic Manhattan building. From start to finish, the process took two years, and the center opened right on schedule.

Developing a center of this size from the ground up was no easy task, says Peter S. Kim, M.D., member of the board of directors at Manhattan Endoscopy Center. But he says it was worth it in the end. "Each one of us had anxiety about transferring our procedures from the office to the ASC," he says. "Without exception, we are all very happy and satisfied."

Dr. Kim and executives from Frontier Healthcare, the development/management company hired to assist in the MEC project, share five tips about starting an ASC.

1. Form a strong board of directors. The first step to creating MEC was to form a board of directors. Many ASCs are formed with physicians from one practice so they're used to working together, but in the case of MEC, most of the physicians were solo practitioners.  Board members must be able to work well together.  Since the Board represents all the members of the group, it is imperative that self-interests are minimized and the concerns and interests of each member are taken into account.  All the members must feel confident that the board represents the interests of every member.  There is a huge time commitment that is required of each board member. "Our board is successful because the physicians are willing to put in the necessary time and we have developed a great camaraderie and mutual trust in working to achieve a common goal," according to Dr. Kim.  


The board of directors consists of five physicians and Jordan Fowler, the founder and CEO of Frontier Healthcare. Dr. Kim says that in addition to monthly meetings, the board is in constant communication utilizing e-mail and telephone conference calls to immediately address any issues or problems that arise.

2. Make sure the development/management company is a good fit. The physician owners decided to hire a development/management company. "The choice is extremely important," he says. "As physician owners we interviewed several groups who were keen to work with us. There are some firms that are national in their viewpoint. Frontier manages ASCs that are predominantly in New York state. They are more familiar with our state's regulations. We felt this would provide an advantage for us. Each state has different regulations; the marketplace is unique."

Another factor in selecting Frontier was how much time, resources and energy the company was willing to devote to the project. "You really need a lot of dedication from the group you select," he says. "A good management company such as Frontier is critical in opening an ASC.  They were instrumental in vetting potential members, helping us draft the operating agreement, finding real estate, obtaining a loan and a line of credit, hiring staff and analyzing our business model.  We were also able to tap into the business relationships Frontier has cultivated through their experience in the opening and management of other ASCs."

3. Hire a nurse manager early. Mr. Fowler says he tends to hire a nurse manager two months before the facility is set to open. Not only can this person spot deficiencies in compliance, but he or she can help train staff before the ASC opens.

"A good nurse manager is as important as a good CEO," he says. "Qualities to look for include proficiency in staff training and noticing deficiencies. There are always deficiencies when you open a large facility. You need someone who is highly proactive and can attend to the physician members, as well as the nurses, administrative staff, plus third party service providers."

The final few weeks before the ASC is scheduled to open are critical for a nurse manager. "All the different pieces that you think about at the very end, that last 10 percent, is easy to overlook," Mr. Fowler says. "Those are the things that contractors, architects and engineers think least about. The nurse manager has to really come into their own in the final weeks prior to opening."

4. Plan early and anticipate. Mr. Fowler says people often underestimate the complexity of opening a center. "You hear anecdotally, some physicians offer the idea that it's a simple project," he says. "It's just a bunch of procedure rooms and walls. It's not that simple. A large ASC project is a major undertaking."

Because opening an ASC is a complex project, it requires time. "You really need to recognize what it takes to open a center this large and understand the time and resources it takes to get a center humming," Roy Bejarano, Frontier COO, says. "It takes more than five to six months post-opening for a large facility to go through all of its growing pains."

While MEC has experienced some growing pains, Dr. Kim sees the efficiency improving day to day. "We are trying to reproduce the efficiency of an office in an ASC setting," he says. "We've improved with each passing month.  There are the inevitable adjustments.  Our center is fully digitalized and for many of our physicians, this was their first experience with using electronic health records.  Efficiency will continue to improve with experience."

5. Be selective with physicians the center recruits. Although well-run ASCs tend to attract physicians, Mr. Fowler stresses the importance in ensuring that every physician joining the center maintains the same high quality of care. "A well-managed facility can act like a center of gravity attracting other successful and qualified physicians who want to be part of a well-run ASC," he says. "We try to make sure that new physician have standards commensurate with the  group. We've seen firsthand how attractive a well-managed site can be."

MEC already has two rounds of physician recruits scheduled to be added to the center over the next year or so. Dr. Kim says all new physicians must agree with the central mission of MEC. "Before the center opened, we tried to identify doctors who we wanted to partner with and who had similar philosophies. We wanted physicians who would prioritize quality in patient care and experience first and foremost."

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