Orthopaedic Surgical Center of the North Shore, founded by the orthopedic surgeons of Sports Medicine North in Peabody, Mass., bills itself as the largest and most successful orthopedic group in New England. John Powell, CEO of this ambulatory surgery center, lists nine proven strategies for an ASC to grow its case volume.
1. Expand the practice. For the ASC to grow, its major practice needs to grow. Since it is unlikely that physicians from competing practices will join the ASC, growth in the same specialty usually has to come from within. The practice now has 15 doctors and three more are joining on Aug. 1. Growth begets more growth. Physicians at Sports Medicine North sought to make their practice so large that hospitals and insurers could not afford to ignore it. "The practice has become the de facto orthopedic department of some hospitals in the area," Mr. Powell says. The practice is always looking for opportunities to grow further. For example, when an orthopedic group straddling the Massachusetts-New Hampshire border pulled out of Massachusetts, it left a hospital without orthopedic physicians. Sports Medicine North quickly filled the vacuum.
2. Use the ASC as a recruiting tool. Just as the practice can benefit the ASC, the ASC can benefit the practice. Take advantage of the synergy between a practice and a surgery center. Orthopaedic Surgical Center of the North Shore, located in the same building as the practice, is a key recruiting tool for the practice. Physicians who join Sports Medicine North have the chance to become an equity partner in the ASC and realize a higher volume than they would have in the hospital.
3. Attract young physicians. Like many specialties, orthopedic practices compete for a limited number of new surgeons coming out of fellowship programs. Certain factors can give a practice the leg up. For instance, some practices start new physicians off as junior partners, but at Sports Medicine North they can go right to being full partners. "Our leadership wants things to be very democratic," he says. The practice has attracted graduating fellows from New York and California.
4. Have a centralized location. "A convenient location means a lot to patients and referring physicians," Mr. Powell says. The practice and ASC are housed in one building on One Orthopedics Drive, one minute off an exit on Route 128, the beltway around Boston. A physical therapy center and an MRI are also housed in the 50,000 square-foot building.
5. Take advantage of local conditions. The Orthopaedic Surgical Center of the North Shore has benefited from Massachusetts' tough CON law. With little chance of obtaining a CON by directly applying for one, the physicians of Sports Medicine North opened the ASC in 2004 without a state license by taking advantage of a loophole in the CON law. , They were able to get a CON by obtaining AAAHC accreditation and Medicare certification. Massachusetts closed this loophole in 2006 and required the ASC to register as either as a single-specialty and or multispecialty. Preferring to be multispecialty, the center qualified for this status by bringing in pain management procedures, an easy fit for orthopedics. At that point, "we planted the seeds to become a multispecialty ASC," Mr. Powell says.
6. Add other specialties. Registering with the state as a multispecialty ASC allowed the center to grow in a way it never would have achieved locked into a single specialty. The center added a number of urologists and rented a lithotripsy machine for them to use at the center a few days a month. "It's much easier if you can branch out to other specialties," Mr. Powell said. Overbuilding the ASC when it first opened made it possible to add more specialties.
7. Adapt to changing circumstances. When Blue Cross Blue Shield of Massachusetts began encouraging patients to have colonoscopies done out of the hospital, the Orthopaedic Surgical Center added GI. This required adding seven more staff members, including techs, nurses and management. The ASC had to buy $150,000 in equipment and set up a procedure room. The new GI program started this January. Five gastroenterologists use the center five days a week, adding a projected 3,000 cases this year and 4,000 next year. For a $700,000 investment in GI, the ASC expects $2 million more per year in reimbursements.
8. Reach out to the community. The surgeons at Orthopaedic Surgical Center of the North Shore and Sports Medicine North make a point of reaching out to the community. "Physicians like ASCs because we are less expensive," Mr. Powell says. The practice has opened three satellites to be convenient for patients. The orthopedic surgeons staff sports injury clinics every Monday evening. They work with sports programs at high schools and colleges and hold education sessions at senior centers and hospitals. "We see referring primary care physicians and potential patients as customers," he says.
9. Plan for future trends. "We don't have a static plan for the future," Mr. Powell says. "We are continually changing it." For example, the practice is in talks with Regina Hertzlinger, professor of business administration at the Harvard Business School, who has just received a federal grant for a global payment pilot. "Participating in the pilot would get us a place at the table," Mr. Powell says. The practice and ASC could parlay the experience to create similar arrangements with local employers. Already, the practice has agreements with employers to treat their workers comp cases. In return, the employers get a discount and a guarantee that patients will be seen within 48 hours.
Learn more about Orthopaedic Surgical Center of the North Shore.
Read more ideas for ASC improvement:
- 9 Points for Orthopedic and Spine Surgeons on Forming Positive Relationships With Hospitals
- 5 Steps to Bring Total Joint Replacements Into Surgery Centers
- 4 Steps to More Satisfied Surgery Center Physicians