Q: At a high level, what is the opportunity for outpatient spine at the moment?
John Caruso: I think the opportunities are excellent for surgeons. But you have to work hard to understand and then seize the opportunity. It took a great deal of effort for us to realize our vision of “one-stop shopping” for spine care. We wanted to make spine care as easy and convenient as calling an 800 number. We knew the patients would love the convenience, but we had to invest a lot of time in studying the regulations and payor contracts to address the requirements for structuring all the businesses. I’m very proud that we figured out operating models that enable imaging, PT and our practice to work together easily and efficiently. In a perfect world, we would’ve opened a physician-owned hospital, but the regulations wouldn’t allow it. For now, we just want to expand our vision so we can serve more patients.
Q: Do you agree with the consensus that outpatient spine will continue to grow?
JC: I am quite optimistic for the simple reason that outpatient spine surgery works at every level. It is a more satisfying and comfortable experience for patients. Surgeons have more control over the clinical environment and the economics make more sense for everyone, including the payors. It’s a win-win-win and that’s why I am a strong advocate for outpatient spine.
Q: Is there a specific innovation in surgical technique, pharmaceuticals or equipment that is most exciting to you?
JC: It’s really the combination of advancements in all these areas that makes outpatient spine ASCs so attractive. Even with more serious cases, like multilevel ACDFs and extensive decompressions, there is less trauma for patients and reduced risk of complications. But, for all the innovations and new technology, careful patient selection and building the right team are the real difference makers when it comes to successful outpatient spine surgeries.
Q: What is the ideal role for a business partner to play in a successful ASC?
JC: I’ve found that doctors can make excellent business decisions if they have access to good information and are focused on the right elements of operating a business. Business partners should provide that information.
For example, in opening a new center, you need rock-solid estimates around case mix and volume. A partner needs to validate surgeons’ guesstimates of the types and numbers of cases they’ll bring. Later on, you need good numbers around things like cash flow and accounts payable, as well as benchmark data and performance targets for these processes. Operational discipline is important, too. So a partner should provide best practices around staffing, training and scheduling.
Q: What advice would you give to younger spine surgeons considering an investment in an ASC?
JC: Work with people you trust. That includes everyone from your back-office team to your OR nurses to your fellow surgeon-owners. A strong, trust-based relationship with your business partner — like we’ve established with Blue Chip Surgical — is also a great asset for ASCs. But the real value of trust is that it enables surgeons to focus on treating patients and have confidence that the business side of operations is being managed effectively.
Thank you to Blue Chip Surgical Center Partners for arranging this article. Blue Chip developed Parkway Surgery Center, along with Dr. Caruso and other surgeon-owners. You can learn more about Blue Chip and read more surgeon stories at www.bluechipsurgical.com/insights.
