Is a specialty ASC in your plans?

Las Vegas-The numbers speak for themselves. Today, there are between 4,500 and 5,000 certified ambulatory surgery centers (ASCs) in the United States-outpacing the number of hospitals offering outpatient surgical procedures. More ASCs are expected to sprout up around the country at a rate of about 8% per year.

Many specialty physicians have moved from hospital settings to ASCs. In doing so, physicians offer patients high-quality service with the best-trained staff and the best-available equipment. Seventy percent of all cataract surgeries are now performed in ASCs, explained Stephen C. Sheppard, CPA, COE, managing principal, Medical Consulting Group LLC, Springfield, MO, who facilitated a panel discussion on ASC operations during the annual meeting of the American Academy of Ophthalmology.

Panelists were Ronald D. Blair, a leading consultant on ASCs and president, Surgery Center Services of America, Mesa, AZ, and physicians Robert Cionni, MD, medical director, Cincinnati Eye Institute, Cincinnati; Richard A. Lewis, MD, partner with Gertz, Mocker, Lewis group, Sacramento, CA; and John Michaelos, MD, director of the St. Michaels Eye and Laser Center, Largo, FL.

If you've been thinking about investing in your own ASC, you can learn from those individuals who already have been through the process, noted Blair, who has been involved in the development of more than 200 eye surgery centers over the past 17 years.

"Patients expect a high-tech, high-touch approach to the services they get today," said Blair. "They are Internet-savvy and do their research ahead of time. They come to us with expectations we didn't see 5 years ago. As a result, the addition of an ASC to clinical practice creates a unique opportunity for physicians to extend the clinical experience. The ASC is not simply a free-standing entity, but has become an extension of the practice."

Dr. Michaelos, sole owner of his ASC, has a simple business philosophy: Treat everyone as you would treat your own family. He opened his facility 7 years ago; today, about 1,500 lens and refractive cornea cases are performed per year (a total of 2,500 cases in all).

He said he believes that patients appreciate how they are treated in a quality facility. "We don't advertise because most of our patients learn about us from word of mouth," Dr. Michaelos said. "The key is quality, having state-of-the-art equipment in place. That's what helps our practice grow."

Other panelists echoed that sentiment, including Dr. Cionni, who said, "We want to be the highest-quality center in the region. I think we've accomplished that with what we've built."

At Cincinnati Eye Institute, physicians had been working in a clinic and operating in a four-room ASC. Today, 42 surgeons work in a new facility with six operating rooms and a 100,000-square-foot clinic. Not all the physicians are owners, but they have the option to buy in after several years of service.

Dr. Lewis, a general partner in his ASC with eight limited partners, emphasized the right combination of equipment and personnel as the components necessary for a successful center. "We opted for purchasing high-end equipment, including the latest microscope for each operating room and the best phacoemulsification machines," Dr. Lewis said. "When you complement that with the right staff, it's a winner."

Developing an ASC

The first step in developing an ASC is to evaluate the regulatory environment in the state where you live, noted Sheppard. "Half the states still have certificate of need laws," he said. "Depending on where you are located, that can obviously constrain the process of getting into a surgery center."

Sheppard advised learning as much as possible about regulations at the local, state, and federal levels, while recognizing that each state is different in terms of interpreting the regulations.