Robert Carrera, president of Pinnacle III, identifies five questions ambulatory surgery centers need to ask themselves when preparing to resyndicate to new investors.
1. Do we have a process in place to properly vet prospective investors? Mr. Carrera suggests using the same process with these investors as that which was utilized with your initial group of investors. "If you're not properly conducting due diligence on the front end, it's inevitable that you're going to end up with someone who is not the partner you wanted," he says.
2. Do these investors share our philosophies? The physicians you're considering bringing in to your ASC should have philosophies that align with the philosophies embodied by your current physicians and any outside investors, such as a hospital or management company, says Mr. Carrera.
3. Are they physicians we want to be associated with from a quality standpoint? Mr. Carrera recommends ASCs learn as much as they can about prospective investors, including any information available about them from a quality standpoint. "Are they considered slow and/or expensive?" he asks. "From a quality perspective, would you feel comfortable with your family member going to them? All of those things go into determining whether someone should or would be considered a good partner or investor in the center."
4. Do we know their other commitments in the community? This is an important question to ask because you need to know what might prevent these physicians from bringing cases to your center or distract them from their commitment to your ASC. You also want to learn this information because if they are invested in other ASCs, these partnerships could make it difficult for them to meet safe harbor regulations.
"Is it a situation where they have so many other investments that in a year from now, they're going to have a hard time filling out an affidavit stating they meet the compliance guidelines?" Mr. Carrera says.
5. Are we focused too much on bringing in new investors and cases and not enough on whether they're the right fit? This question ties back into the first question of following a process that will help ensure new investors are good, long-term partners. Mr. Carrera has observed some ASCs overlook a prospective physician's poor reputation and focus more on the cases he or she could bring to the facility. "They'll go for quantity as opposed to quality," he says. "[Some facilities] are jumping at any opportunity to hook an additional investor."
While the number of available physicians for recruitment has declined, it is critical for ASCs to not rush a decision on bringing in a new partner. "It's not inexpensive to bring people into the partnership," Mr. Carrera says. "Significant levels of both financial and human resources are put out there to get them into the partnership. If you didn't do your due diligence, you may find yourself actively working on removing or trying to remove a newly recruited physician, which is going to create additional expenses."
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