Robert Zasa, managing partner of ASD Management in Pasadena, Calif., lists five top reasons why surgeons still join ambulatory surgery centers.
1. Control of the OR. "Doctors really desire control of the operating room itself — the people, the supplies and instrumentation they use, right down to the flow of the room," Mr. Zasa says. "Having the same nurse for your procedures and having a small group of the same anesthesiologists has a big impact on efficiency."
In contrast, the surgeon in the hospital works with different people all the time. By having the same people, "the surgeon is faster and more efficient," he says. "Staff members gain a great deal of proficiency doing the same type of procedures on a routine basis." The nurse who always works with the same physician knows his procedures very well.
2. Control of the schedule. Block scheduling, another rarity in the hospital, provides for optimal efficiency in the ASC. "The ability to do several cases in a row on the same day on a routine basis puts ASC efficiency head and shoulders above the hospital," Mr. Zasa says. "The surgeon can come in, do all his cases for the day and go back to the office. He doesn't have to go back and forth." Blocks make the scheduler more productive, because she almost always works with the same times. Turnover time can be low — about 10 minutes or less, on average, at an ASC — because the cases in one surgeon's block tend to be similar.
3. Generating extra revenue. In the ASC, the facility fee goes to the physician-partners, not the hospital. Since surgeons have a share in the fees, they are rewarded if they are efficient. "If they do the case at the hospital they get nothing," Mr. Zasa observes. "An ASC is one of the few things that surgeons can legally own, so they should take advantage of it."
4. Introducing new procedures. Surgeons can grow their practice by introducing new outpatient services in the ASC. For example, a bariatric surgeon can do lap-band surgery instead of just gastric surgery. Spine surgeons can move quickly to outpatient spine and pain physicians can start using spine stimulators without having to slog through hospital bureaucracy to get approval. "The ASC-based surgeon is able to generate new volume and allow the practice to grow," Mr. Zasa says.
5. Becoming part of a network. Physicians from different practices who work together in an ASC have formed the basis for other mutually beneficial arrangements. In this era of accountable care organizations, clinics without walls and bundled payments, "doctors can no longer afford to be isolated," Mr. Zasa says. "They have to be in networks with other doctors." By working together, physicians can leverage better managed care contracts, reach out to primary care physicians and conduct marketing.
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