Becker's ASC Review published a column on the "5 Worst Specialties for Surgery Centers" in mid-April and asked readers to provide their thoughts and feedback. Here are six responses to the report. You can share your comments by emailing rob@beckersasc.com.
1. David Murphy, DPM, FACFAS, Ankle & Foot Associates and The Institute for Corrective Surgery of the Foot and Ankle, Georgia: After reading your article on surgery centers and their worst candidates for success, I am compelled to refute [some of the claims made].
Alleging that "Podiatrists tend to be more technical than surgical" is a little narrow minded. Since the late 1980s, podiatric residency programs have been producing well trained surgeons that have elevated the level of care and the scope of practice as it pertains to lower extremity health. Graduates from today's podiatric residency programs are minimum three-year surgically trained, many are four-year trained and fellowships beyond that are commonplace.
And ironically, during all that training, little if any time is devoted to "designing orthotics inserts," which by the way is redundant [as] an orthotic is an insert. Furthermore, we are almost never designing — orthotics are fabricated by a reference lab in almost all cases.
2. Jeffrey Shanton, director of business management at Journal Square Surgical Center in Jersey City, N.J.: I disagree with some aspects of this article. Good luck with centers being able (or fortunate) enough to base their business on orthopedics, spine, etc. There's not enough to go around. The whole notion of a center is to be multi-specialty, and success should depend upon multiple specialties, not just one or a couple. If the insurers suddenly sour on one, you have others to fall back on, or if reimbursement suddenly changes for one, you have other things to do.
I state for the record that I would take a good podiatrist (reconstructive) as a substitute for orthopedics any day, not the least for the fact that they tend not to be prima donnas!
I have experience. I come from a center that had two podiatrists that did over $1 million in revenue each, for three years — a more than ample substitute for an orthopod.
OB/GYNs: These are also great revenue producers. Hysteroscopy, balloon ablations (carriers will pay for the kit by the way) — these are good mid-level doctors and specialties. In addition, insurance carriers routinely pay this with no questions asked.
3. Leslie Cottrell, RN, Director of Nursing, Baptist-Physicians' Surgery Center, Lexington, Ky.: I generally agree with the points made in this piece except on GYN. We do a large volume of GYN and it is profitable for us. We do dilation and curettage, hysteroscopy, diangostic laparoscopy with laser, endometrial ablations and some others. We do a small amount of plastics for the size of our ASC.
4. Comment attributed to "Calvin Eng": I think this list is relative. For example, plastics. Yes, it ties up an OR, but you would definitely want to put plastic cases on your low volume days, and it's up to management to negotiate a profitable cash fee. Normally, management should establish a set fee up front. And if the doctor goes over his allotted time, the center must balance bill the patient. This ensures that the center does not lose money, and if the doctor knows that his patient will be balance-billed, that will give him an incentive to stay focus.
I disagree that podiatry is not a good source of income. It could be the area that your facility is located. But if your facility does have a low volume podiatry rate, it doesn't necessarily mean it's costly for the center. With proper management, podiatry cases are quick, so you can plug them in between other cases to better utilize an OR room. The absolute worst is having a case in the A.M., a huge gap, then another case in the P.M. (Having idle staff is costly). Why not stick that case in to offset your overhead? Or schedule your podiatry cases on your slow days.
Yes, certain cases are OR hogs and certain specialties do not generate a profitable reimbursement. But managing the time and making sure there's an accurate cost analysis, can easily help offset your overhead.
Lastly, never give a low volume specialty, prime-time. It's should always be on a first-come-first-serve basis.
5. Comment attributed to "kc": Regarding podiatrists in this article is a bunch of crap! Podiatrists are very surgical! They are foot and ankle surgeons. Anyone who commits to an ASC will generate cases. In fact, all ASCs I know of put podiatrists in high regard and the case loads are phenomenal! In fact, podiatry is very sought after. Regarding them not being an MD — so what? That has nothing to do with whether one brings lots of cases or not! What about hand surgeons — good for ASCs? Not all oral surgeons are MDs as well! Besides, all ASCs I am affiliated with all have podiatry as one of its top earning specialties!
6. Comment attributed to "Toedoc": That's an interesting comment about podiatrists. My local hospitals get reimbursed $25K-30K for cases that are less than an hour in length. The comment about podiatrists not being MDs shows your ignorance — we are doctors of podiatric medicine who perform foot and ankle surgery. Yes we do fabricate orthotics as a part of complete podiatric care, but that's like saying an eye specialist writes prescriptions for glasses so...
Note: All comments have undergone review and editing in preparation for publication.