Since it opened almost 25 years ago, the Ambulatory Surgery Center of Greater New York in the Bronx has remained an ophthalmology-only ASC. Jerome H. Levy, MD, managing director and medical director of the center, lists eight steps that have made it successful.
1. Maintain high volume. "To this day, the center has been successful in filling its schedule with ophthalmology-only cases," Dr. Levy says. It logs 8,000-plus cases a year, a high figure for just two ORs. Having more than two high-volume surgeons is a safety net, so if a surgeon either retires or moves the center will maintain sufficient volume to remain profitable.
2. Reach out beyond the practice. Like many one-specialty facilities, the center started with surgeons from one practice, but immediately sought outside surgeons. The ASC is in the same building as the practice, but "we realized we needed to reach out to other physicians to fully utilize the efficiency of the ASC and to improve revenue," Dr. Levy says. In addition to five surgeons in the core practice, outside ophthalmologists now account for 58 percent of the center's volume. The outside surgeons come from many parts of the New York area, including many major hospital centers.
"It can be difficult for an ASC closely affiliated with one practice to attract surgeons from other practices, especially when the ASC is in the same building as the host practice," Dr. Levy says. "Outside surgeons may suspect that surgeons in the practice are getting special treatment or may even try to take their patients away." Center staff and host surgeons have to be very sensitive about such concerns and always make sure outside physicians feel that in bringing their patients here, they will remain their patients.
3. Open on evenings and weekends. With normal hours filled, the only way to increase volume was to open on off-hours. The center already maintains evening hours and is considering opening on Saturday, Sunday or both days. When opening on weekends, pay attention to the cost of staffing and reimbursement of cases scheduled for that time.
4. Include retina surgery. Retina surgery presents a great growth opportunity for ASCs, especially since the Medicare facility fee for retina surgery was raised at the beginning of 2011. "We haven't lost money on retina, even when the facility fee for it was lower, because we chose only the most efficient retina surgeons," Dr. Levy says. Since retina is a longer procedure than cataract surgery, the center schedules these cases in the evening. "Patients may not consider evening surgery as their first choice, but they're thrilled with shorter waiting times and much fewer inconveniences than in the hospital setting," he says.
There are additional benefits to having strong relationships with retina surgeons, Dr. Levy says. These surgeons often send their cataract patients to the center's cataract surgeons, and if a cataract surgeon has a retina problem onsite, one of the retina surgeons can easily be summoned.
5. Reward high-volume surgeons. The center caters to the high-volume surgeons by giving them use of both ORs at once. Their OR turnover time is faster, since one room can be turned over while the surgeon is working in the other.
6. Keep looking for new recruits. "Even though we already have a high volume, we're always looking for new surgeons," Dr. Levy says. "Through extensive networking, our administrative staff is consistently looking for good surgeons who desire to increase their efficiency."
Ideal candidates are surgeons in their 30s or 40s who have been in practice for a number of years. "We identify candidates and ask them to come and take a look at our operations," he says. "Then we'll give them part of a surgery day to try out the facility and see if they're comfortable with us –– and we're comfortable with them. It's a two-way relationship. If it works out, they are able to join the ASC attending staff." After a certain amount of time, new physicians with a significant volume of surgery are considered for a percentage of ownership.
7. Hire great staff. "A key ingredient to our success is that we supply highly trained staff members who are attentive to details," Dr. Levy says. "They should have positive attitudes and maintain good communication with the surgeon and the surgeon's office staff."
8. Treat surgeons like royalty. "Our staff treats all surgeons like royalty," Dr. Levy says. They are attentive to little things that can make a difference, such as putting the names of the outside surgeons on top of "the board," the list of surgeons scheduled at the center for that day, which patients see when they walk in.
Related Articles on Improving Ophthalmic ASCs:
10 Steps to Improve Quality and Efficiency in Cataract Surgery
8 Factors Affecting Ophthalmologist Compensation
Dr. Peter Colquhoun Discusses Four Opportunities for Ophthalmology at Surgery Centers in 2010