As more procedures shift to the ASC setting, leaders are evaluating which specialties or service lines will be the best positioned for development in the coming years — and how this can be done safely and efficiently.
Here are three notes on how ASC leaders are thinking about service line expansion:
1. Lay out all of the financials. Having a clear financial picture of how much a service line addition or expansion will cost — ranging from the investment in new technology to new hires or more real estate — is a key first step in the process.
“Do your homework. Use a detailed financial plan and a practical assessment. Analyze the plan and determine if the new service line or expansion will deliver a return on investment,” Tina DiMarino, RN, CEO of Custom Surgical Consultants, told Becker’s. “This means getting realistic estimates of patient volume and the revenue those cases will bring in. In addition, understand all the associated costs.”
Many costs associated with new service line expansions may be difficult to identify early on, which is why partnerships with consultants or colleagues with the proper experience can be make-or-break for smaller centers with less financial flexibility.
“This process often uncovers hidden expenses for necessary equipment, specialized instruments or single-use supplies,” Ms. DiMarino said. “If the service line is in a new specialty to the center, bringing in a consultant or working with a colleague is a smart move to ensure no detail is missed.”
2. Specialty-specific considerations. Cardiology is the fastest growing ASC specialty, according to Avanza’s “2022 Key ASC Benchmarks and Industry Figures” report, with many leaders and organizations eager to expand into the space.
This excitement has only been heightened by CMS’ proposed addition of nearly 276 procedures to the ASC Covered Procedures List, a sign that payers may become increasingly aligned with outpatient cardiology.
But ASC leaders looking to add cardiology services should become familiar with the specific demands of the specialty in the ASC space.
“The biggest thing I can advise is that people wanting to venture into cardiology need to know this is a critical care specialty. It requires critically trained techs, nurses and practitioners who are familiar with the risks, technology and treatments involved,” Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s in 2024. “These may not be present in the standard ASC patient. Things like screening patients differently and having well-trained cardiac rad techs and heart techs are key. You can’t put a surgery tech in a catheterization lab or a cardiology case and expect them not to feel uncomfortable.”
3. Securing the right talent. The process of expanding a service line at an ASC can be tedious and require solid alignment between administrators, physicians, nurses and other support staff.
Thomas Jeneby MD, a plastic surgeon in San Antonio, told Becker’s that assembling a flexible and communicative team of physicians and nurses is of the utmost importance when expanding service lines.
“What is the temperament of the new physicians? Are they ‘needy’ with a ton of requests for expensive equipment or supplies? Do you have a nurse or tech that has done these before (ask around – you would be surprised)?” he said. “The recovery of these patients — are there nuances to it? Again — [do] any nurses have experience with those types of patients? Hire a champion part-time if not. How long is that doctor going to operate there so you can pay back the equipment cost? Can you rent or have vendors bring them in? Beware the ‘jumping’ surgeon or physician who leaves the surgi-center over the slightest issue!”
