Bryant Smith, regional vice president of development for NovaMed, discusses six questions every ambulatory surgery center leader should ask when considering a new specialty.
1. How will the new specialty affect scheduling and efficiency? Mr. Smith says the first question to ask when adding a new specialty is, "What type of specialty can be easily added to the existing set-up without causing too much trouble?" If your ASC has a small waiting area, pre-op area or post-op area, adding a high-volume surgeon might cause flow issues and disrupt your facility's efficiency. "I have personally experienced this numerous times," he says. "It can be done, but you may have to give that high-flow surgeon his or her own day. Can you afford to do that? Will the other physicians move their block to accommodate?" If the physician will bring enough revenue to the center to justify opening up an entire day, it might be worth it to add the specialty.
2. Which specialty will bring in the most revenue? Mr. Smith says determining revenue and profitability is essential before adding a specialty. He says NovaMed generally considers orthopedics, spine and pain first, as those specialties are currently bringing in the best revenue for the company. "We still pursue ophthalmology as well, but many of those surgeons are already tied into an existing surgery center," he says. General surgeons, ENT, GYN, urology and GI surgeons may be worth considering if they are a good fit for the center. For example, many general surgeons are so closely tied to the hospital that they will bring few cases to your center. ENT can be profitable if your state regulations are not overly cumbersome for pediatric patients. GYN and urology typically bring low case volume, and a GI surgeon must be very high-volume and efficient to make the specialty profitable.
3. Will you need to renegotiate existing contracts? Don't overlook your existing contracts when adding a new specialty, Mr. Smith says. "Just because you make $2,000 on a shoulder scope in Tennessee doesn't mean you will make that in Florida," he says. Ask your managed care department to look at your existing contracts and determine whether you will need to renegotiate contracts to make your new cases profitable.
4. Which local physicians are available for recruitment? Once you have decided on a specialty, you must recruit a surgeon who will fit with the center and help the new specialty succeed at your facility. "I typically create a database of all surgeons in that specialty in a 15-mile radius of the center," Mr. Smith says. "I then take that list and meet with anyone and everyone [that] can give me valuable information." He says he wants to know as soon as possible:
• How busy is the surgeon?
• How fast is the surgeon?
• Is the surgeon associated with another facility? Where does he or she work now?
• Is the surgeon expensive?
• Is the surgeon high-maintenance?
He says the best sources of information are generally anesthesia providers and vendor representatives, who work in multiple facilities and can provide non-biased information. You should also speak with nurses, ASC directors and physician partners. If one of these sources can introduce you to the potential surgeon, use that avenue; otherwise, ask if you can use the source's name when you meet the surgeon. "I always center my message around the surgery center," Mr. Smith says. "The center provides them with a more efficient workplace and is a much better experience for their patients." He cautions administrators not to lead with the financials; distributions may not provide "life-changing money" and should not be the focal point of your pitch.
5. Where can you find staff to handle the new specialty? In some cases, your ASC may already have staff members who are familiar with your new specialty. In other cases, you will have to recruit staff from a local hospital or another center. "Recruiting staff to your center is similar to recruiting a physician, just not nearly as long or difficult of a process," Mr. Smith says. "The easiest way to do it is to ask the surgeons you are bringing in, 'Is there someone at the hospital or another center that we should target?' Someone at their office?" He says if a staff member is not willing to join the center as a full-time employee, you can ask if this person would come over to the ASC to train existing staff on the new specialty for a few months. He says NovaMed has sent existing staff members to work in other facilities to train for the new specialty. Just make sure you provide competent staff from the beginning or you may risk losing your new surgeon.
6. What new equipment will you need to purchase? When a new surgeon visits a NovaMed facility, Mr. Smith sits down with the surgeon to discuss new equipment. "I ask that they get their physician preference cards from the hospital," he says. "I find out what pieces [of equipment] are ultra-important and what ones are 'me too' products that we can just price shop and get the best deal."
More profitable specialties will allow you to purchase more expensive equipment. "If a spine surgeon needs a specific C-Arm and he is going to bring us 10 cases a month, then you pay extra for the C-Arm," Mr. Smith says. Ask your materials manager to negotiate aggressively with vendors for a good deal on equipment. Don't start by buying every piece of equipment on the market; purchase enough to get the physician started at the center and consider new purchases down the line.
Learn more about NovaMed.
Read more advice on operating a successful ambulatory surgery center:
-10 Ways Cabell Huntington Surgery Center Saved $200K in One Year
-5 Critical Questions to Ask Before a Surgery Center Invests in Spine
-5 Ways a Surgery Center's Location Impacts its Business
1. How will the new specialty affect scheduling and efficiency? Mr. Smith says the first question to ask when adding a new specialty is, "What type of specialty can be easily added to the existing set-up without causing too much trouble?" If your ASC has a small waiting area, pre-op area or post-op area, adding a high-volume surgeon might cause flow issues and disrupt your facility's efficiency. "I have personally experienced this numerous times," he says. "It can be done, but you may have to give that high-flow surgeon his or her own day. Can you afford to do that? Will the other physicians move their block to accommodate?" If the physician will bring enough revenue to the center to justify opening up an entire day, it might be worth it to add the specialty.
2. Which specialty will bring in the most revenue? Mr. Smith says determining revenue and profitability is essential before adding a specialty. He says NovaMed generally considers orthopedics, spine and pain first, as those specialties are currently bringing in the best revenue for the company. "We still pursue ophthalmology as well, but many of those surgeons are already tied into an existing surgery center," he says. General surgeons, ENT, GYN, urology and GI surgeons may be worth considering if they are a good fit for the center. For example, many general surgeons are so closely tied to the hospital that they will bring few cases to your center. ENT can be profitable if your state regulations are not overly cumbersome for pediatric patients. GYN and urology typically bring low case volume, and a GI surgeon must be very high-volume and efficient to make the specialty profitable.
3. Will you need to renegotiate existing contracts? Don't overlook your existing contracts when adding a new specialty, Mr. Smith says. "Just because you make $2,000 on a shoulder scope in Tennessee doesn't mean you will make that in Florida," he says. Ask your managed care department to look at your existing contracts and determine whether you will need to renegotiate contracts to make your new cases profitable.
4. Which local physicians are available for recruitment? Once you have decided on a specialty, you must recruit a surgeon who will fit with the center and help the new specialty succeed at your facility. "I typically create a database of all surgeons in that specialty in a 15-mile radius of the center," Mr. Smith says. "I then take that list and meet with anyone and everyone [that] can give me valuable information." He says he wants to know as soon as possible:
• How busy is the surgeon?
• How fast is the surgeon?
• Is the surgeon associated with another facility? Where does he or she work now?
• Is the surgeon expensive?
• Is the surgeon high-maintenance?
He says the best sources of information are generally anesthesia providers and vendor representatives, who work in multiple facilities and can provide non-biased information. You should also speak with nurses, ASC directors and physician partners. If one of these sources can introduce you to the potential surgeon, use that avenue; otherwise, ask if you can use the source's name when you meet the surgeon. "I always center my message around the surgery center," Mr. Smith says. "The center provides them with a more efficient workplace and is a much better experience for their patients." He cautions administrators not to lead with the financials; distributions may not provide "life-changing money" and should not be the focal point of your pitch.
5. Where can you find staff to handle the new specialty? In some cases, your ASC may already have staff members who are familiar with your new specialty. In other cases, you will have to recruit staff from a local hospital or another center. "Recruiting staff to your center is similar to recruiting a physician, just not nearly as long or difficult of a process," Mr. Smith says. "The easiest way to do it is to ask the surgeons you are bringing in, 'Is there someone at the hospital or another center that we should target?' Someone at their office?" He says if a staff member is not willing to join the center as a full-time employee, you can ask if this person would come over to the ASC to train existing staff on the new specialty for a few months. He says NovaMed has sent existing staff members to work in other facilities to train for the new specialty. Just make sure you provide competent staff from the beginning or you may risk losing your new surgeon.
6. What new equipment will you need to purchase? When a new surgeon visits a NovaMed facility, Mr. Smith sits down with the surgeon to discuss new equipment. "I ask that they get their physician preference cards from the hospital," he says. "I find out what pieces [of equipment] are ultra-important and what ones are 'me too' products that we can just price shop and get the best deal."
More profitable specialties will allow you to purchase more expensive equipment. "If a spine surgeon needs a specific C-Arm and he is going to bring us 10 cases a month, then you pay extra for the C-Arm," Mr. Smith says. Ask your materials manager to negotiate aggressively with vendors for a good deal on equipment. Don't start by buying every piece of equipment on the market; purchase enough to get the physician started at the center and consider new purchases down the line.
Learn more about NovaMed.
Read more advice on operating a successful ambulatory surgery center:
-10 Ways Cabell Huntington Surgery Center Saved $200K in One Year
-5 Critical Questions to Ask Before a Surgery Center Invests in Spine
-5 Ways a Surgery Center's Location Impacts its Business