December 2017


Preparing for changes in ophthalmology
5 tips to start an ASC

by Vanessa Caceres EyeWorld Contributing Writer

Dr. Chu performs surgery.
Source: Y. Ralph Chu, MD

Surgicenters offer greater growth potential and control for surgeons, but do your homework first

If there’s one word that comes up repeatedly when you ask ophthalmologists about the advantages of participating in or starting their own ambulatory surgery center (ASC)/surgicenter, it’s efficiency.
“The nature of a surgicenter is about quality care and efficiency,” said Richard G. Davis, MD, Precision Eye Care, an Ophthalmic Consultants of Long Island partner, Huntington, New York. “Single-specialty surgicenters can achieve efficiencies impossible for a hospital system or even a multispecialty ASC as they have the advantage of focusing on one mission.”
Dr. Davis gave the example of being able to do four cataract surgeries per hour at the ASC where he is a founding partner versus only 1.5 per hour with a local hospital system.
The sole focus on ophthalmology at a single-specialty ASC makes a big difference in contrast to surgery at a multispecialty center.
“Everyone’s focused on the eye,” said Bradley Black, MD, Dr. Black’s Eye Associates, Jeffersonville, Indiana. “There aren’t crying kids waiting for tubes in their ears.” Surgical centers can also offer convenience for ophthalmic surgeons as well as their patients, who likely won’t have to travel as far for surgery, Dr. Black said.
A center focused on the eye ensures there are personnel who are both interested and trained in ophthalmic surgery, said Robert Nelson, PA-C, executive director, Island Eye Surgicenter, Westbury, New York. In many hospital centers, ophthalmic surgery may seem like a mystery. “If you don’t do it daily, you get frightened of it,” he said, commenting on staff such as OR nurses at other facilities who may work with eye surgery only occasionally. Hospitals can also be less eager to work with eye surgery as it’s less of a profit center, he added.
An ophthalmic-focused eye center ensures greater surgeon control over procedures and even the technology used. “Compared to a large multispecialty hospital with many layers of bureaucracy and the many different players involved in the decision, a smaller and more focused ASC typically can gain access to newer technologies more quickly,” said Y. Ralph Chu, MD, Chu Vision Institute, Bloomington, Minnesota. He gave the example of femtosecond lasers, noting that ophthalmic-specific centers were among the first in the U.S. to have access to these.
“The need for new technology is essential in order to recruit the younger and better surgeons,” said Jerome Levy, MD, Ambulatory Surgery Center of Greater New York, Bronx, New York.
Ambulatory surgery centers are likely to experience continued growth, Dr. Davis predicted, especially if payments to hospital systems are lowered to be on par with ASCs. “It opens great opportunity to ASC owners, a chance for real savings on the Medicare side and quality care for patients,” he said.
Of course, this isn’t to say that starting an ASC is easy or without challenges. They come with a large start-up cost, and you have to make sure you have the surgical volume—on your own or with partners—to make it pay off. There are also reimbursement challenges. “I think the challenges in the future for ASCs will be securing fair reimbursement as compared to hospital outpatient departments as well as facing and adapting to the ever-changing regulatory environment,” Dr. Chu said.
“The stronger, more efficient surgery centers will survive,” Dr. Levy said.
If you think you may be ready to make the leap to participating in a local ASC or starting your own, keep these suggestions in mind.
The following are 5 tips to start or join an ASC.

Tip 1: Seek help

“Don’t think you can do it yourself,” Mr. Nelson cautioned. The process of starting a center can be difficult, and he should know. The center he operates recently opened at a new location after 17 years at the original site. The new location is open access and has twice the number of ORs (six total), two CATALYS femtosecond lasers (Johnson & Johnson Vision, Santa Ana, California), and is about three times the original size.
Among the list of professionals you’ll want to speak with are other ASC owners, a healthcare attorney, and an experienced architect. Most of the sources interviewed for this article said that the Outpatient Ophthalmic Surgery Society (OOSS) is an invaluable resource. The group serves 1,000 ophthalmic-focused centers and 500 additional ones that work with multispecialties, according to the OOSS website.

Tip 2: Consider current market, volume, and potential growth

Naturally, you’ll want to serve a larger volume of patients before you open a surgicenter. However, even if you only have moderate volume, are you willing to approach local colleagues to start a center together? This is another common scenario. Aiming for a center that’s open full time may make it easier in terms of hiring full-time staff instead of part timers, Dr. Black said. To help expand volume, his center also has retina surgeons who use it.
Another consideration is whether there are other surgicenters in your area. Even if there are, are they eye-focused or multispecialty? Your market may have a need for an ophthalmic-only center.
As you plan the size for your center, you don’t want to make it too big, but you do want to consider your growth potential. Mr. Nelson’s center, with 16 partners and 60+ surgeons on staff, was quickly outgrowing its old location. When they occupied their new locale in March of this year, they had not planned to open the fifth OR until this fall, but that OR opened in July due to demand. “Now the question is if we should have built eight ORs, but that’s water under the bridge,” Mr. Nelson said.

Tip 3: Select an architect and a contractor with surgical center experience

Mr. Nelson said that he can’t emphasize this enough. Your architect should have a solid history of working with surgery centers, and your general contractor should have hospital and/or surgery center experience. There should be no exceptions as the construction standards are very stringent.

Tip 4: Brainstorm ways you can cut costs

In the pre-construction phase, one thing Mr. Nelson wished he knew was that some group purchasing organizations can save money not only on equipment costs but also on construction supplies. That could lead to a savings of 30–40% on items like drywall, studs, paint, and even elevators. “The additional savings could have been significant,” he said. “We only wished we had engaged early on. We saved some on drywall, paint, carpets, and ceiling tiles, but didn’t fully benefit from the potential savings.”
Once you’re in your ASC and thinking about equipment and technology costs, Dr. Black said you may want to consider roll-on/roll-off lasers versus purchasing a laser. For example, if you’re in a rural area where you don’t have the volume for daily surgery, a roll-on/roll-off laser could be ideal—and the companies will even provide personnel. Dr. Black also uses a roll-on/roll-off laser at a satellite location.
There are also groups like the Vision Center Network of America, which is a clinically integrated network of surgery centers in New Jersey and New York that can negotiate contracts with payers for quality and possible bundling. Dr. Levy founded this group.

Tip 5: Take a tour and get on the schedule if you’re not ready to make a leap

If you’re not ready to own or become a partner in a center, take a tour and see if it’s a good fit for you, Dr. Davis suggested. Then see if there is a surgery time available to operate in the center. “As the volume of cases grows, the possibility of buying shares in the ASC can be discussed,” Dr. Chu said.

Editors’ note: The sources have no financial interests related to their comments.

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