Almost no new ASCs have been approved in the past few years, says Bob Nelson, administrator of Island Eye Surgery Center in Carle Place, N.Y. That’s actually been good for Mr. Nelson’s center, a three-OR facility with 15 partners on Long Island.
In states with little or no CON regulations, many ASCs are now suffering from overbuilding, struggling with low volumes and working hard to recruit just one or two new surgeons. But Island Eye Surgery, with few competitors around, has a 96 percent OR-utilization rate and little room for new surgeons.
Fixing a different set of problems
The New York ASC has a different set of problems. “We turn doctors away every day,” Mr. Nelson says. Hospital-based ophthalmologists have been knocking at Island Eye Surgery’s doors because they have been getting lousy block times, with start times at 3-4 p.m., in addition to putting up with the usual inefficiencies of a hospital-based OR, he says.
With 36 surgeons now using the ASC, Island Eye Surgery has had to work very hard to find room for more surgery volume. A few years ago, “we were at the point where our volume looked like it would peak out,” Mr. Nelson says. The schedule got so tight that “some of our doctors may have had to do their cases back at the hospital. We didn’t want that.”
So the physician-owners decided to extend the end of the day from 5 p.m. to 7 p.m. and open up block times for more surgeons to use the ASC. Under the new scheduling process, “two nurses are constantly monitoring the schedule,” Mr. Nelson says. “Doctors are calling them all the time, asking ‘Is there additional time?'” If no case is scheduled, they give the time slot away.
Considering adding more ORs
Now that reimbursement for retina surgery has improved, the physician-owners would now like to add it to the ASC. “We have retina specialists in the wings,” Mr. Nelson says, “but where do you add retina?” For this to happen, the owners would have to add rooms to the three-OR facility.
In spite of the state’s tough CON process, adding ORs to an already approved facility is relatively easy. It means applying for an “extension clinic, which the state tends to act favorably on, Mr. Nelson says. But planning and building the new center would be challenging. Island Surgery will have to look for new real estate, which is not cheap on Long Island and the process would take 1.5-2 years.
The 15 partners meet in November to decide on the expansion. Mr. Nelson says he is not sure how the vote will go. “Every doctor has a very different risk tolerance,” he says.
Learn more about the Island Eye Surgery Center.
