The other thing I talk about is my background, which is unique among most surgeons I know. You may wonder why my personal history is relevant to a decision to join an ASC, which many surgeons consider mainly in financial terms. My working-class background led me to specialize in orthopedic surgery and workers’ compensation cases. This is not, I’d be the first to admit, the most glamorous specialty in medicine today. But helping workers get back on the job more quickly is a calling for me, and a highly rewarding one. And being a partner in our surgical center allows me to use state-of-the-art surgical techniques and participate in a truly innovative business. Best of all, it has helped me fulfill my dreams.
A win-win-win
I have a pretty intense personal connection with my patients, who work in warehouses and manufacturing plants. I consider them my people, like those I grew up with in New Jersey. I want the best for them — attentive staff, top-flight equipment, a comfortable environment — because that’s what they deserve. Having my own center gives me the power and freedom to provide it. I work with nurses, anesthesiologists and pain management specialists who are experienced in specific procedures and in outpatient environments. I like the people I work with and have a hand in saying who joins the team. That translates to a better patient experience and excellent outcomes.
For patients, ASCs offer many benefits. Minimally invasive techniques, more personal levels of care and a non-intimidating environment all minimize the trauma of surgeries. The easier parking makes a huge difference, too. Compared to huge campuses and the towering garages at most hospitals, freestanding ASCs are much easier to navigate. Such practical considerations are very important to the overall patient experience.
The finances of ASC ownership make sense, too. The ancillary income is very nice — especially since it comes through a facility where patients come first. There’s no trade-off. The efficiency, productivity and faster turnarounds appeal to me. Indeed, increased productivity is the main purpose of surgical centers, compared to low-productivity environments at hospitals, which, in effect, devalue doctors’ time. I have found that I’m 35-50 percent more productive in the OR at our surgical center than when operating at the hospital. Further, because of the convenient location and the efficient design of the center, I can schedule anthrograms, imaging sessions and other procedures around major surgeries.
Administration issues don’t cut into my productivity. Because we teamed with a skilled and experienced partner to manage the business, I don’t have to worry about solving operational or billing problems on my own. Again, that keeps me free to focus on the patients.
Let’s not forget the payors, who are also fans of ASCs. Often, the payors are employers who save money because treatments often cost less to perform at ASCs than at hospitals. Patient satisfaction also matters to payors. Patients tell me they like the experience, and they also tell their primary care physicians and benefits managers, who in turn tell the worker’s comp carriers and employers. The direct feedback from referring docs and patients is fulfilling and motivating. Call it what you want — a win-win-win or a virtuous circle — it works.
ASCs are also very well-suited for unconventional specialties or niches like mine. Again, worker’s comp ortho is not a high-glamour field that attracts a lot of doctors, but I’m passionate about it and have enormously enjoyed practicing it for nearly 20 years. If there was a weak link in the patient experience, it was when patients had to go to hospitals for surgeries or major treatments. Unfortunately, many hospitals are not enthusiastic about routine orthopedic procedures. They want to focus on their Centers of Excellence for total joint solutions, open-heart surgery, gastric bypass and the like. Therefore, all the top anesthesiologists, best OR nurses and most advanced equipment are allocated to those specialties. For my operations, the support staff might be unfamiliar with ACL reconstructions or rotator cuff surgeries — the bread and butter of my practice — or the way I prefer to work in the OR. I don’t mean to pick on hospitals, but that’s the way it is.
Entering the ASC business
A few years ago, I started handling surgeries at an ASC in East Portland. The facility was struggling under its corporate owners at the time, and I was among a number of physicians who expressed interest in purchasing the facility, or at least a large stake in it. Though the business wasn’t working, we liked operating there. Certainly, it was preferable to the local hospitals.
We entered into negotiations with the corporate owners, and it was clear the pricing was way off. Some doctors who are skeptical of ASCs have faced this situation before. But I don’t think the owner or the potential management companies we spoke with were interested in real partnerships. We couldn’t seem to get straightforward answers to our questions or the information we needed to determine what it would take for the facility to succeed. Instead, we got lots of smoke and mirrors.
Finding the right partner
Eventually, we found the partner that was right for us, but it took some time. Based on my experience, I would say that expertise and experience in operating successful ASCs aren’t the only factors to consider when choosing a partner, though the specific criteria will change for every ASC. First and foremost, our group wanted a business partner who was fully committed to quality care. We also liked seeing a clear and credible plan for the business, tailored to our unique situation and with roles and responsibilities spelled out for all to see. The ability and confidence to make specific recommendations about the optimal of doctors and mix of specialties and cases was a plus, as was willingness to share information openly. By no means are these standard operating practices at many ASC development firms.
Other matters to take into account are knowledge of the local market, understanding of reimbursement rates and regulatory issues, and effective working relationships with lawyers, accountants, equipment makers and others who make ASCs work.
When they have a partner like this, doctors have nothing to fear from getting into the ASC business. If everybody knows what it takes to succeed and what’s required of them, then the partnership has the solid foundation it needs. And as a caregiver, I don’t have to worry about all the operational, administrative and organizational details. It’s comforting to know that skilled, experienced people I trust are taking care of those matters. Choosing the right partner — in our case Blue Chip Surgical Center Partners — is one reason why the East Portland Surgical Center is functioning effectively and profitably today.
An unconventional career path
Again, my view of medicine and business has been greatly influenced by my background. I was born to a working-class family in rural New Jersey. Through my teens, I worked on farms, in residential construction, and at paper mills. After dropping out of college to help with the family finances, I took a Christmas job in the warehouse at UPS and became a driver until I was laid off.
While waiting to be called back to work, a friend offered me a job as an orderly in a hospital. This experience ignited a passion for medicine. I became an X-ray Technologist, which supported my return to college, this time as a pre-med student. After being accepted to Rutgers Medical School, I started my own contracting business doing renovation carpentry to finance my education. Later, I was accepted to Oregon Health Sciences University and completed residencies in general surgery and orthopedic surgery.
The bottom line: Practicing the way you want
After beginning private practice in 1988, I quickly discovered I was most comfortable caring for working people — the same people I had been around all my life. It was a good fit all the way around. So, after 12 years practicing in general orthopedics, I established Occupational Orthopedics in 2000, the only specialty practice in the U.S. that provides personalized care exclusively for injured workers. Though there’s been much trial and error, it has been the most gratifying and purposeful activity of my professional life.
The people I treat are my people, and that’s why I want the best possible environment for them. Our Occupational Orthopedics offices and the East Portland Surgical Center provide that environment. There are many great things about running your own practice in your own facilities, but for me the best benefit is that I can be 100 percent responsible for and focused on the quality of care and the comfort of my patients. I can assemble the right team to support me, and I don’t have to worry about lots of administrative hassles or sudden changes in the operating schedule that waste my time and my patients’ time. The distractions are fewer and I can keep my focus right where it belongs — on helping injured workers get healthy and back to work as soon as possible. I am in control and, like most physicians I know, I like it that way.
–John DiPaola, MD, is founder of Occupational Orthopedics and a partner at East Portland (Ore.) Surgical Center. Learn more about Dr. DiPaola’s practice at www.occortho.com.
Learn more about Blue Chip Surgical Center Partners.
