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ASC Team

Harnessing the Power of Your ASC Team

By ASC Governance, ASC Management, Leadership No Comments

Organizations who harness the power of teamwork thrive.  You can sense their vibrant energy the minute you step through their front door.  Positive momentum permeates every aspect of their business.  Their collaborative spirit is infectious.        

Teamwork in your ASC can easily make the difference between your place of business being merely another place to work or a workplace of choice.  It can also make the difference between your ASC being yet another place to receive care or the preferred patient option for ambulatory surgical services. 

ASC leaders who understand who makes up their team and what allows for a dynamic work environment are better equipped to harness the power of their team.

The diagram above is a visual representation of an ASC’s stakeholders.  Let’s explore how to engage individual team members to create a vibrant team.

What is Important to the team?

Whether an ASC is in the planning stages, has recently opened, or is in its tenth year of operation, the organization’s mission statement is critical to developing and maintaining its goals.   It serves as the cornerstone of the ASC’s culture. 

A properly crafted mission statement –

  • Communicates the purpose of the organization
  • Serves as a filter to separate what is, and is not, important to the organization
  • Clearly states which markets the organization will serve and how
  • Communicates a sense of intended direction to the entire organization

The mission statement guides the actions of the ASC, articulates its overall goals, provides a path to achieve those goals, and ensures decision-making is in keeping with those goals.  It provides the framework to develop the company’s strategies.

When crafting a mission statement, consider –

  • Quality and consistency
  • Customer service
  • Diversity and individuality
  • Professionalism
  • Specific ideals of a sponsoring or partnering health system or organization

Although it is not uncommon for a mission statement to remain the same over time, it should not remain static due to inattention or apathy.  Markets, goals, leadership, and organizations change and evolve.  Review your mission statement on a regular basis to ensure it reflects any substantial changes.

The Team


As I have discussed in other posts, physicians become members of ASCs for a variety of reasons. Ensure you recruit physicians based on how they will function as part of your team. Careful selection is the key to success. If physicians participate for the right reasons and their previous track record demonstrates they are “team players,” integrating them into your team should not be difficult.

Because physicians interact daily with your patients and staff, it is critical for them to buy into, and actively support, the ASC’s mission and culture.  There is no quicker way to undermine the effectiveness of your workplace than to work with physicians who do not respect your organization’s purpose.

Board of Managers

Ideally, the ASC’s Board of Managers (BOM) should create the facility’s mission statement, be involved in its regular review, and develop any revisions.  By setting the facility’s policies and procedures, hiring its medical director and management team, and crafting the mission statement, the BOM is the de facto owner of the ASC’s culture.

BOMs facilitate team dynamics when they are comprised of a diverse group of investors, representing different physician groups and specialties.  When the facility is joint ventured, it is important to include hospital executive representation on the BOM.

Ultimately, the most important characteristic for board members to possess is a willingness to participate and devote the time necessary to enthusiastically engage in facility-related discussions. Board members who stay informed about facility performance and operations and consider the perspectives of all stakeholders regarding ASC topics make sound business decisions.

Medical Director

The medical director is selected by the BOM.  As with physicians, this selection needs to be based on the individual’s track record of being a “team player.” Initially, the medical director will be involved in developing the ASC’s policies and procedures.

Most importantly, the medical director is charged with supporting clinical and administrative staff, enforcing policies and procedures (along with the BOM), and effectively maintaining the facility’s culture.  This will include addressing professional issues related to physicians and staff that are averse to the desired team environment.  The medical director will also function as a team member in multiple operational areas including scheduling, staffing, inventory, operating room utilization, etc.

Clinical and Administrative Staff

A popular saying is, “Hire the right people and get out of their way.”  This holds true not only for employee skill sets and work ethic, but also for their ability to effectively function as members of a team.  Educating staff about the ASC’s mission and the BOM’s commitment to that mission sets the stage for a well-informed team ready to fulfill the desired expectations.

It is critical to support and empower clinical and administrative staff to take action and make the decisions necessary to fulfill the ASC’s mission.  For example, they must feel comfortable reaching out to ASC leadership when quality of care or customer service issues are being compromised.

As new team members are added through growth or attrition, ensure a consistent message is relayed by the physician owners, BOM, medical director, and the facility’s management team. This will ensure the desired team dynamic is preserved.


Management is comprised of the ASC’s administrator and their team of program leaders.  The role of management is to own the ASC’s mission and consistently promote that message to all team members in the facility.  This is the responsibility the BOM entrusts to the center’s management. Management accomplishes this by expecting, promoting, and modeling excellent working interactions among all stakeholders.  Recognizing the contributions of all team members in pursuit of the ASC’s goals and carrying out its mission allows a team atmosphere to flourish.  

Finally, management is responsible for ensuring team members who are not bought into the organization’s mission, or do not have the skill set to contribute to that mission, are appropriately removed from the mix.  Jim Collins, renowned management consultant and author, said, “The only way to deliver to the people who are achieving is to not burden them with the people who are not achieving.” [1]


In conclusion, I am reminded of a speech given by legendary University of Michigan football coach Bo Schembechler.  It is simply referred to as “The Team! The Team! The Team!”  There are numerous YouTube versions of the speech.  My personal favorite is one pulled from a news clip (approximately 2 minutes long).  In his speech, Bo reminds us there is nothing in life we will achieve as an individual that will provide us more personal satisfaction than what we will achieve as a member of a team.  The team can be defined in many ways – your family, your place of worship, your work place – the list goes on.  The underlying message is this:  leaders need to provide the unwavering vision, mission, and culture necessary to make sure all stakeholders have a chance to experience the sense of team accomplishment described so powerfully in Bo’s speech.

Robert Carrera – President/CEO

[1] Good to Great:  Why Some Companies Make the Leap & Others Don’t, James C. Collins, 2001

Convalescent Care Center

Value Proposition: Adding a Convalescent Care Center to Your ASC

By ASC Development, ASC Governance, ASC Management, Leadership 2 Comments

If your ASC operates in a state that allows convalescent care centers, there are numerous benefits of adding one to your existing continuum of care.  We outline some of those benefits in this value proposition.  

Convalescent Center Value Proposition

In some states, an ASC may maintain a separately licensed convalescent care center as part of its service offering.  This separate licensure provides an ASC with the opportunity to keep most commercial patients beyond the standard 23-hour stay of a regularly licensed ASC.  The extended stay is granted for observation and pain control for more extensive outpatient procedures.  

The ASC is generally directly compensated for the additional recovery time in the convalescent center.  Compensation occurs in a variety of ways including hourly rates, per day rates, or increased consideration in global or bundled fee arrangements.  In addition, the ASC may be indirectly compensated by securing greater reimbursement from commercial payers on lower acuity cases.  This is because payors recognize cost savings occur when higher acuity cases safely move from a hospital to an ASC with extended stay capability.  

The primary advantage for an ASC with a licensed convalescent center is the potential to provide services to higher acuity surgical patients.  Orthopaedics and neurosurgery specialties benefit most from this advantage, specifically in total joint replacement and spinal surgery.

The types of orthopaedic cases requiring extended stay that are well-suited for an ASC connected to a convalescent care center are: 

  • Patella femoral arthroplasty
  • Total hip arthroplasty
  • Total knee arthroplasty
  • Total shoulder arthroplasty
  • Total ankle arthroplasty

These cases traditionally restricted both physicians and patients to an inpatient setting.  Although moving them to an outpatient setting represents significant savings for insurance carriers and patients alike, these higher acuity cases can provide a net revenue per case increase of 300-400% over traditional ASC orthopaedic cases.

Other types of extended stay cases well-suited for this arrangement are orthopaedic-spine and neuro-spine.  Specifically, the following:

  • Single and multi-level anterior and/or posterior cervical and lumbar fusions
  • Cervical and lumbar disc arthroplasty

Again, these spine cases may have traditionally restricted physicians and patients to inpatient settings.   Cost-savings for both insurance carriers and patients also occur when these cases move to ASCs with separately licensed convalescent centers.  The result for ASCs can be a net revenue per case increase of 600-700% over traditional orthopaedic cases and 250% above traditional spine cases.

Another advantage of these separately licensed facilities over inpatient hospitals and orthopaedic specialty hospitals occurs in payor contracting.  The value proposition for commercial payors, workers’ compensation, auto insurers, and the general public is significant.  A contracting advantage for surgeons in terms of future health care reimbursement may also be realized.  Future reimbursement will likely include, but not be limited to:  bundled payments, pay-for-performance, at risk contracting, clinically integrated networks, consumer-driven care, and price transparency.

Finally, having the capacity to accommodate higher acuity and higher paying surgical cases enhances surgeon and partner recruitment. With the saturation of “commodity” ASCs, an ASC with an adjoining convalescent care center offers the benefits of a mini-hospital. This is attractive to surgeons who may not otherwise be interested in using your facility, much less investing in it. 

What Value Does a Convalescent Center Represent for You?

Investigating convalescent care center licensure requirements in your state is a worthwhile endeavor if your facility is interested in performing higher acuity cases.  If your state allows these types of centers, conduct a thorough cost-benefit analysis to determine the feasibility of establishing one in conjunction with your ASC. 

If your state does not currently afford ASCs the opportunity to establish an adjoining convalescent center, consider these benefits, network with other facilities, then work together to rally legislative support for them in your locale.

Pinnacle III Leadership Team

ASC Trends

New White Paper! Looking Ahead: 10 ASC Trends and Developments to Watch in 2017

By ASC Development, ASC Governance, ASC Management, Leadership, Payor Contracting, Revenue Cycle Management No Comments

We are excited to release our latest white paper – 10 ASC Trends and Developments to Watch in 2017.

We are still in the early months of 2017, but it is already shaping up to be an interesting year in health care — one that is likely to be a mix of uncertainties, challenges, and opportunities.

Fortunately for ASCs, they are well-positioned to thrive in the rapidly changing and evolving marketplace.  They may even be able to improve their position by planning for and effectively responding to trends and developments.

The 2017 trends and developments for ASCs identified by our leadership team include a forecast for strong industry growth, interest in adding new specialties, and continued migration of higher acuity cases to ASCs.

Changes in the relationship between ASCs and payors are impacting reimbursement especially in facilities who do not have strong revenue cycle management solutions.  Bundled payment programs and the growing number of self-insured employers continue to create marketing opportunities.

Unfortunately, the continued escalation of the financial responsibility borne by patients present revenue challenges.  And, a rise in cyberattacks has disrupted health care, bringing cybersecurity to the provider forefront.

Finally, educating patients, physicians, health systems, and payors on the value of ASCs remains a top priority. Raising this awareness is crucial to fuel the growth the ASC industry is primed to experience in 2017.

In summarizing what’s ahead in 2017 for ASCs, Trista Sandoval, our Director of Business Development & Physician Relations, said:

“One of our main strategies is to continue to focus on raising awareness of ASCs as a high-quality, low-cost option for care, and doing what we can to drive applicable outpatient cases to our ASCs. That may take the form of helping hospital systems build their own ASCs, educating patients through direct consumer marketing, or reaching out to physicians to build awareness of the ASC setting as a viable option for their procedures.”

Through such efforts, Pinnacle III’s leadership team believe ASCs will thrive in 2017.

To read the full report, download the white paper here: 

The Pinnacle III Marketing Team

surgeon recruiting

Become A Surgeon Recruiting Master for Your ASC with these Sales Tips

By ASC Management, Leadership No Comments

The recruitment of new physicians to an existing ASC is an essential component of surgery center management. Most ASC administrators are not trained sales/marketing professionals, nor are they supported by a sales force. Here are some tips I have found helpful as I’ve become self-trained in this area over the years.

Identifying potential new surgeons

  • Determine if they meet the criteria your board of managers has established for physicians in your center. Please see my previous blog post for a list of criteria to consider in vetting new surgeons.
  • Be aware of new surgeons moving to your area. Ask your current physicians and the manufacturer representatives who frequently visit your facility to alert you when new doctors enter your market.  Periodically review the list of newly licensed physicians who have recently moved to your area.
  • If your ASC is in a joint venture relationship with a hospital or health care system, work closely with their business development, marketing, or physician liaison team to identify prospects.
  • Target physicians who are unhappy at their current center. Disgruntled physicians oftentimes express their dissatisfaction in their current center’s ORs, hospital ORs, or hospital locker rooms.  You can often garner this information from the representatives mentioned previously, your existing surgeons, or your anesthesiologists who encounter them in these environments.

Setting yourself up for success

Once you have identified a single physician or a group of physicians as prospects, it’s time for the sale. Don’t be afraid of that word.   We’ve all engaged in sales.  At the very least, you sold yourself to your employer to secure your job.  Selling your facility is not that different.  Forge ahead – call the physician’s office and arrange a time to meet with them.

  • Determine what your objective is for the meeting. Is it getting the physician to the ASC for a tour?  Or securing the physician’s agreement to complete a credentialing packet?
  • Research your prospect to learn anything you can about them. Where did they go to school? Where did they train?  What procedures do they perform?  Do they have any dislikes?  If so, what are they?
  • Identify your needs and anticipate their wants. For example, you know you want them at your center, but can you accommodate their preferred day and time.  Determine how to deal with these kinds of scenarios ahead of time and be prepared to present options.
  • Determine what information you need to bring to the meeting. If you have specific information regarding a program you offer, bring that with you to present if afforded the opportunity.  When you have someone on your team who knows a lot about the surgeon’s specialty and will assist in closing the deal, bring them with you.
  • Know your competition. What will other centers be able to offer them?  What were they unhappy about elsewhere?  Prepare to address these topics in a subtle way.
  • Be aware of any previous history between this physician and your facility, or any stakeholders in your facility. Prepare to address these issues.
  • Think win-win. You must bring value to your facility, the physician, and the physician’s scheduler(s).  A one-sided relationship will never work.

Delivering what you promised

Let’s say you’ve identified your prospective surgeon(s) and had a successful meeting with them.  You were so successful, in fact, they are now scheduling cases at your center.  Now you need to ensure your team delivers what you promised.

  • Educate and empower your staff. Brief your staff on the physician’s expectations and what you promised.  Perform a dry run of the surgeon’s cases if you think it will assist the staff provide outstanding customer service.
  • Ensure the physician’s preference cards are correct and everything needed is present, including properly sized scrubs and gloves.
  • Make sure you are in the facility as the physician arrives for their first day. Welcome them, thank them for being there, and follow up with them at the end of the day. These are best practices to maintain for all your doctors every single day.
  • Attempt to schedule them with a consistent team.
  • Communicate, communicate, communicate!

Winning over the schedulers

Lastly, when recruiting new surgeons to your ASC, avoid underestimating the power of their scheduler(s).  I’ve been in many surgeon’s offices where the scheduler determines where their surgeon will perform a case.  I’ve spoken with numerous surgeons who’ve told me they go where their scheduler tells them to go. You must win their schedulers over!

What do schedulers want?

  • The path of least resistance. A full offering of managed care plans allows them to readily determine what procedures and/or surgeries can be performed at the center. And, if the physician has a set block time available, it’s easier for the scheduler to offer specific days to their patients.
  • We all want to do business with people we trust and like. Schedulers are no different.  They like people with “can do” attitudes.
  • They want to schedule at the time they call. Oftentimes the patient is standing there when they are making appointments.
  • They do not want to be put on hold. If this is unavoidable, ensure the hold time is short.
  • Little to no paperwork. We need information from the physician’s office but the process for exchanging information should be streamlined.

The best advice in recruiting new surgeons is to maintain open lines of communication among all parties.  This allows you to capture wants, needs, and dislikes.  Once you have this information, you can work toward creating a situation that satisfies everyone’s needs.  Your surgery center will be the preferred place of choice and you’ll be happy you created this environment from day one.

Robert Carrera – President/CEO

Ambulatory Surgery Center Associations

The Importance of State Ambulatory Surgery Center Associations

By ASC Development, Leadership No Comments

Involvement in your state surgery center association is crucial to the vitality, longevity, and success of your ASC.  Perhaps my personal story will demonstrate why.

I am a proud, active member of the Colorado Ambulatory Surgery Center Association (CASCA) and have been since its inception.  Throughout most of its early years, when the association was forming, those of us in the ASC industry met monthly for lunch and networking.  Because there wasn’t much going on then that directly impacted the regulatory status of Colorado’s ASCs, these meetings eventually waned.  The association became dormant. 

However, in 1993 news broke of looming threats to the convalescent care licensure, the elimination of which would have negatively impacted many of the state’s facilities.   Convalescent care centers were important to patients who needed non-acute extended observation and recovery following their outpatient surgeries.  Without the ability for patients to access convalescent care centers, higher acuity cases could not be performed in the ASC setting. Our state’s ASC leaders rallied.  The association reorganized.  Strong leadership took the helm.  With renewed focus, CASCA prevented the legislation from passing.  ASCs in Colorado won!

That victory was a turning point for our association.  We realized the trade organization was necessary to ensure ASCs remained relevant in our state. Furthermore, the association’s advocacy efforts made it possible for us to remain aware of the issues facing our industry.  

State ASC associations provide government advocacy, education, regulatory updates, and other resources to assist us in running our businesses successfully. To provide these services, the association requires active membership.  Increased representation and participation from ASCs in our state allows us to have a greater voice.   The association survives through membership participation.  Members can, and should be, involved with planning the annual conference, participating on committees, and/or helping with political fundraisers.

Being an active member allows for beneficial change to occur.  It’s important to reach out to legislators (in person, via phone, email, and/or letters) when faced with situations that may impact your ASC’s culture, values, or continued viability.  You, your staff, and your patients are constituents. Our legislators want to hear from you about issues important to your physicians and community.  You can successfully impact the outcome of these issues when you are involved.

They say there is power in numbers.  That power is your state ASC association. 

Here’s how you can get involved:

  1. Contact your state association. A quick Google search should direct you to their website. Or use your connections in the ASC industry to inquire about your association and who you should contact.
  2. Contact your national association, Ambulatory Surgery Center Association (ASCA) to remain apprised of issues and information related to advocacy, government affairs, and education.
  3. Connect with me and/or other members of Pinnacle III’s team to learn more about regulatory updates that may impact your ASC. LinkedIn: and, Twitter: @LisaAustin_P3 and @PinnacleIII
  4. If you don’t like or agree with the direction of proposed legislation or policies, create change by participating in and/or donating to organizations you believe will help your cause.

Lisa Austin – Vice President of Facility Development 

Celebrating Milestones

Celebrating Milestones at Your Aging ASC

By ASC Management, Leadership No Comments

Most ambulatory surgery center (ASC) owners and investors desire longevity for their facility. When your facility reaches important milestones, it’s important to capitalize on them.    

An important anniversary is an excellent opportunity to host an event or execute other marketing initiatives that demonstrate appreciation for investors, foster relationships, build community interest, and educate providers and consumers about the services you provide.  Here are some tips on promoting and/or celebrating your ASC’s stability in the market and thoughts about what you will likely gain in return for your efforts.

Opportunities and Gains

Not celebrating a milestone your ASC has reached is one of the greatest missed opportunities in facility management.  An official celebratory event can seem like a daunting project.  However, the return on investment can be quite rewarding when accomplished strategically and executed appropriately. 

The Surgery Center at Lutheran in Wheat Ridge, Colorado, decided it was best to hold two separate events to celebrate their ten-year anniversary.  The first, a celebration dinner held at a local restaurant, honored the surgery center’s physicians and staff for their long-time dedication to the center and patients in their local community.   Showing appreciation and gratitude for those who have stuck with you throughout the years strengthens employee engagement, creates social and prosocial interactions, and enhances productivity.

The second event, a cocktail hour open house held at the ASC, allowed the surgery center to invite everyone in its extended network.  It created a platform and opportunity for people from all levels of health care to gather in the same room.  Beyond networking, individuals had the opportunity to discuss issues they face every day.  Because those issues resonated with their colleagues, their conversations afforded them time to view them from alternate perspectives and discuss solutions beneficial to all parties.

An ASC open house creates an opportunity to increase business.  Prospective surgeons can tour your facility and meet your team.  This may help them make the decision to credential at your facility and begin performing cases.  Inviting referring providers gives them the opportunity to meet with specialists and strengthen the referral relationship. 

In today’s health care delivery model, primary care physicians (PCPs) rarely, if ever, take call at the hospital.  As a result, PCPs have minimal opportunities to connect with specialists in the hospital setting.  By touring your ASC during an open house, primary care providers can talk with their patients about the facility they are sending them to for surgery based on firsthand knowledge. This increases everyone’s comfort level and enhances the physician-patient relationship.  

Extending open house invitations to third-party payor representatives allows them a chance to view the inclusive services you offer.  Many payor contracting representatives, although familiar with the ASC model, rarely have opportunities to interact with your facility’s surgeons and staff in the actual location where their insureds are receiving care.  

Inviting local news sources will create an occasion for them to document a great story that demonstrates your ASC’s stability to community members.

Best Practices for Execution


If you are going to celebrate an important milestone with an event at your facility, the first step is collaboration.  Make sure to reach out to your physician practices to see if they are interested in collaborating on the celebration.  Give them the chance to joint-market at your event to boost their business.

Fine tune your invite list

Consider who to send invitations to and why.  Send invitations to individuals in your ASC’s network whom you feel have had the greatest impact on your past success and could impact your continued success.  Have good representation from your own facility to serve as the face of your center during the event.  Invitees to consider include your staff, your physicians, your physicians’ practice staff, your board members, members of the hospital administration, bank representatives, device company representatives, third-party payor representatives, referring providers, employees of the ASC’s management firm, employees of the billing office (if outsourced), local legislators, and local news publications. 

Work with your affiliated physician practices to determine which referring providers to add to your invitation list.  Important local legislators to consider are the mayor, city council, county commissioners, the governor, US senators and representatives, state senators and representatives, leadership in the local government’s business development/economic development department(s), and leadership in the local government’s health and human services department.  Consider inviting members of your state and national ASC associations.

Showing off your business

Some of the preparations for your event will include coordinating with your administrator and clinical staff to lead facility tours.  A facility tour is one of the most enriching experiences for facility guests.  Whether it is during an important celebratory event or during a regular business meeting, taking a guest on a tour of your facility allows them to see all the impressive components of your business model.  It allows you to highlight your successes and the ways in which your ASC is changing and/or leading the health care industry.

Involving key leaders

As you approach the event date, consider asking one of your leaders (i.e. board president, medical director, and/or other board members) to offer a toast.  By allowing your leader(s) to speak about why the ASC is important to them, guests will receive a more complete picture of your ASC and how they may impact its success going forward.

Tying up loose ends that you may not have considered

When following-up with your ASC board members after the event, make sure to highlight key attendees, such as local legislators, or prospective physicians who have interest in joining your medical staff.  These key attendees will demonstrate the value added from a celebratory event. 

Other follow-up includes communicating with local news sources.  Provide an update for news publications that attended as well as those who did not attend.  Being featured in the media is the ultimate cap off to a successful milestone celebratory event!


Any milestone reached in serving the community is an important accomplishment for an ASC.  When your ASC reaches five years, or ten years, or even twenty years, don’t let the opportunities pass you by.  Not only is this a great time for “spring cleaning,” it’s a chance to make the most of your ASC’s long-term success.  Recognition does not have to begin or end with a celebratory event.  Capitalize on your ASC’s accomplishments throughout the year. 

Jack Mast – Physician Liaison

2016 ASC Industry Year in Review

New White Paper! 2016 ASC Industry Year in Review: 10 Key Takeaways

By ASC Development, ASC Governance, ASC Management, Leadership No Comments

We are excited to release our latest white paper – 2016 ASC Industry Year in Review: 10 Key Takeaways.

As we start the new year, it is worthwhile to examine trends and developments that helped shape the ASC industry in 2016.  These trends and developments will most likely set the tone for 2017 and beyond.

Key industry takeaways identified by our leadership include renewed focus on the migration of inpatient surgical care to outpatient settings and a surprising abundance of de novo development.

While momentum for alternative payment models stalled, the impact of implant reimbursement and increased patient financial responsibility dominated operational discussions.  Challenges presented by nursing shortages, increased regulatory compliance, and the demand for more data continued to be hot topics.

Garnering insights from these areas of focus is important given the prominent role ASCs perform in the delivery of affordable quality care.

In summarizing 2016, our Principal Partner, Rick DeHart, stated:

“From my perspective, 2016 was a transitional year for ASCs.  A significant amount of time was spent focusing on the election and anticipating its impact on the future. Everyone was waiting for much of that activity to finish . . . We may see even more activity in the industry in 2017.  Surgery centers are certainly well-positioned to be the low-cost, high-quality provider of choice for an increasing number of patients.”

To read the full report, download the white paper here:

-The Pinnacle III Marketing Team

Recruiting Surgeons

Questions to Consider when Recruiting Surgeons to Your ASC

By ASC Management, Leadership No Comments

There will come a time when your ASC will need to recruit new surgeons.  Whether it’s for a new, thriving, or struggling ASC, recruiting new surgeons is a continual priority.  The selection process for adding physician members to your ASC is critical to becoming and remaining a prosperous center.

Ask yourself the following questions when recruiting surgeons.

  1. What is the surgeon’s character/competence?

If the surgeon has been problematic in the health care community and has established a reputation as being difficult to work with, consider the impact they may have at your center.  If you would not send a family member to them for surgery, would you associate yourself professionally with them?  Choose your partners wisely.

  1. What is the return on investment (ROI)?

Not all cases, or case mixes, are created equal.  Sometimes an ASC is not the best place for certain procedures or specialties.  To obtain an understanding of the ROI, evaluate the surgeon’s CPT codes and case mix.  Compare these to your facility’s existing contracts (or the proposed contract rates if you are evaluating a startup situation).  Avoid assuming all cases and surgeons are alike when it comes to supplies, staffing, and implant usage.  Perform due diligence on what a surgeon utilizes or what a case requires.  Additionally, payor mix will play a significant role in determining how appropriate a surgeon is for your ASC.  If you do not want to contract with a particular payor, and that payor represents a significant portion of a surgeon’s cases, recruiting that surgeon may not be the best move for you.

  1. Is there exclusivity or conflicting interests?

In the late 1990s, there were very few ASCs and they performed very well. In the early 2000s, word got out ASCs were a viable means of augmenting a physician’s income and improving their quality of life.  Thus, in many parts of the country, ASCs proliferated.  This proliferation contributed to physicians diluting their cases across many ASCs.  This was not a problem when the ASCs serviced distinct geographic areas and did not jeopardize the physician’s ability to meet federal Safe Harbor requirements.  However, that is not reflective of the current environment.  When considering surgeons for membership in your center, vet any other ASC investments they may have. Determine how those investments might impact their commitment to your center, as well as their ability to meet federal and ASC specific requirements.

  1. Are you clearly defining expectations?

We all do better when clear expectations are established ahead of time. This is no different for ASC physician members.  You can accomplish this via the center’s operating agreement and bylaws.  I like to consider these documents the ASC’s prenuptial agreement.  Allow boards and steering committees to clearly define responses to issues they may encounter down the road by addressing them proactively in these documents.  These can include, but are not limited to, behavioral expectations, dictation expectations, non-compete provisions, Safe Harbor compliance, buy/sell agreements, and enforcement.  All potential members need to thoroughly read and acknowledge their agreement with these documents before you consider them for membership.  Lastly, if you are evaluating membership for new surgeons in an existing ASC, consider implementing a trial period of three to six months.  This allows all parties to ensure the center is a good fit.

Use these questions to assist you with your recruitment initiatives.   Remind ASC leadership when seeking new members, it’s typically easier to obtain a divorce than it is to remove an undesirable surgery center partner.  This fact makes the vetting of new partners that much more important. Remember, it is never as simple as “s/he has a lot of cases.”

Robert Carrera – President and CEO

Attract Surgeons

How to Retain & Attract Surgeons to Your ASC

By ASC Management, Leadership No Comments

Do you have a favorite store where you enjoy shopping? It may be convenient to your home or office. They always seem to have what you need.  And, when you can’t find something, friendly staff members are readily available to assist you. It may not be the least expensive place, but the service and atmosphere make the extra dollars spent worthwhile.

Think about your favorite restaurant – perhaps the excellent food was the original draw.  But you keep going back because the service and overall feeling you have while you are there adds to your overall enjoyment.  It wins out often despite the multitude of dining options available to you.

Then there’s that shop you use to service your car or bike.  When you call, they always remember you.  When you walk in the door, the owner and staff greet you as if they genuinely care about your business.  They provide you with service options that may not always be the most profitable for them, but may make the most financial sense to you.

When we consider how to retain and attract surgeons to our surgery centers, it is helpful to keep these types of experiences in mind.  I purposely mentioned retain first.   It is much easier and less expensive to keep current business than it is to attract new business.  This is especially true for surgeons in an ASC. Emulate the owners and staff members at your favorite businesses who provide you with the quality customer service you appreciate.  Ensure the actions and attitudes of everyone at your center convey to your physicians their business is valued.

Surgeons use ASCs for a variety of reasons.  Here are six ways you may be able to attract them to your center:

  1. Consistently provide outstanding customer service. One size doesn’t fit all.  Surgeons value different aspects of their customer experience.  They may be drawn to measurable factors – low infection and transfer rates or high patient and physician satisfaction, for example.  Or, it may be as simple as the reliable availability of competent staff, the proper equipment, and necessary supplies.
  2. Save them time. When you save surgeons time, you improve their quality of life.  This can be as simple as your center being near their home or office which reduces time in the car.   On time starts and rapid room turnover times strongly impact surgeon time.  And, if the scheduling process is convenient for physicians and their staff, they are more inclined to use your ASC.
  3. Ensure quality. In today’s healthcare environment, quality should be a given.  When we are asked to revitalize struggling centers, we rarely encounter ASCs providing poor quality of care. Surgeons look for measurable factors when assessing quality – make this information available to them.   They also want to see the high nurse to patient ratios they have come to expect in an ASC.  Lastly, quality usually comes down to perception – is your staff knowledgeable, skilled, and experienced?
  4. Offer extensive managed care participation. Provided you are not an out-of-network center, physicians and their offices do not want to have to choose their site of service based on remembering which center participates with which third party payor. Being able to offer surgeons the full spectrum of managed care plans in your market makes your center a more desirable place to work.
  5. Provide return on investment. Most investors subscribe to a simple formula.  If they are receiving distributions – tangible ROI – they are much more likely to participate.  If distributions are far and few between, investor participation decreases and your ASC has minimal opportunities to recruit new surgeons.  Managing your center in a fiscally responsible way with financial stewardship in mind affords you opportunities to both retain and attract new physicians. 
  6. Add value. Be able to answer the question, “What have you done for me lately?”  Constantly look for ways to add value to the lives and practices of the surgeons who use your ASC.  Focus on the items I’ve outlined above and never rest on your laurels.

Rob Carrera – President and CEO

Physician-Hospital Joint Venture

Creating a Firm Foundation for a Successful Physician-Hospital Joint Venture ASC

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Successful physician-hospital joint venture (JV) ambulatory surgery centers (ASCs) should be built on foundations of alignment that allow both parties to reap the benefits of the partnership.  Physicians seek greater autonomy, efficiency, convenience, and potentially more favorable contracts while hospitals (or health systems) want to expand or maintain their relationship with area physician groups.  Hospitals recognize their service continuum must include outpatient strategies to maintain a well-balanced customer base while physicians appreciate the stability and potential leverage health care systems can bring to the project.  Both parties seek to provide quality care at an affordable price and a reasonable return on their investment.

Entering into a JV relationship can be fraught with difficulties.  However, when executed well, both parties can be pleased with the end result and maintain long term satisfaction.  Here are eight building blocks that place JVs on the path to success.

Secure professional help.  Find an independent third party with a successful track record of developing and managing joint venture ASCs who will provide the expertise necessary to avoid pitfalls in the start-up process as well as in the ongoing operations of the JV.  An independent organization provides a neutral voice devoid of the politics that may exist between physician groups, specialties, and/or health systems. They are also able to verify data and information gathered during the initial planning stages – and later on during operations – that JV parties can rely upon to make sound business decisions.

The JV should also secure the services of an experienced health care attorney to draft operating agreements and other organizational documents that will allow the group to avoid potential conflicts.

Set clear expectations.  Make sure the JV partners set clear expectations not only for the final project, but also for the process of completing the project. First, the group should select members to participate in a steering committee.  While these individuals may not end up being the final governing board, they should be able to commit to attending meetings and conference calls. They should be entrusted with voting on key topics when necessary. Decision making time frames should be agreed upon upfront to ensure none of the involved parties is under the impression that others are dragging their feet.

Determine the ownership and governance structure. Is there a compelling reason for one group to have more ownership than another? Is the ownership split in such a way that the attorney and regulatory bodies will not take issue with the proposed structure?

Identify the hospital’s or health system’s role in the project.  The role of the hospital or health system should be thoroughly discussed and clearly determined. What will their contribution be to the project? Are they contributing capital, land, a building, access to controlled lives, purchasing power, leasing of staff, services, and/or payor contracting/relations?

Define the goal of the project.  It is also important to discuss the goal of the project. Is the JV ASC the end all result? Or, is it the beginning of a larger initiative to create closer alignment between all stakeholders?

Perform a thorough feasibility analysis.  If the JV still seems feasible and advisable after these steps have been taken, a thorough feasibility analysis should be conducted.  DO NOT ASSUME IT WILL WORK! This is one of the biggest mistakes groups make. They do not thoroughly vet the concept before proceeding. The feasibility analysis should leave the potential participants with a business plan, payor reimbursement assessment, and a complete financial pro forma.  This information can be used to obtain philosophical buy-in from investors, tell the steering committee they need to go back to the drawing board, or scuttle a bad project.

Pare down the size of the steering committee.  If the project still looks like a go after these stages, reduce steering committee membership down to a more manageable size.  This smaller sized steering committee – which may end up being the ASC’s governing body – is necessary to streamline decision making and set deadlines that will be adhered to. These individuals should be able to commit to timely communication either in person or electronically.

Avoid common joint venture pitfalls.  Unclear expectations can leave some participants disappointed.  Others may feel the project did not turn out as expected or is not meeting their needs.  One group may feel they have been taken advantage of if incentives are not properly aligned among the project participants.    Poor contracting, an over- or under-built facility, poorly staffed, poorly equipped, or poorly capitalized project can leave investors questioning the financial modeling that was performed.

Lastly, the primary cause of problems is poor or non-existent communication.  Surprises are fine, but not when they impact your livelihood or finances. Not every, but many, of the issues in your joint venture project can be avoided with clear, timely communication.

The benefits of entering into a joint venture ASC are plentiful. The difference between a successful JV and one that limps along or is full of strife is often tied to the planning that occurred upfront.  If you get that right, you’ve won half the battle!

Robert J. Carrera – President and CEO