Gastroenterological ambulatory surgery centers are becoming rarer as the reimbursement rates for GI procedures continue to dip, and physicians and administrators look to more historically profitable specialties.
But GI-driven ASCs can still successful, despite the financial squeeze. John Gleason, executive director of Berks Center for Digestive Health in Wyomissing, Pa., has been in the GI ASC field for 12 years. In that time, he has seen rates drop, but he has also developed ways to keep a center profitable and thriving.
Here are Mr. Gleason's six secrets for developing and sustaining a profitable GI ASC in just about any market.
1. Expand specialty services. Berks is constantly looking at expanding service options for GI patients, Mr. Gleason says. In the last five years, Berks has added a pathology lab for specimens taken at the surgery center and an infusion service.
The first year after the pathology lab opened, Berks kept its revenue steady despite reimbursement cuts. "Without the lab, we would have trouble maintaining," Mr. Gleason says.
He encourages surgery centers to always look toward adding GI-complimentary services such as hemorrhoid banding or PillCam bowel examination. These services can be simple to incorporate into an existing center and can bring supplemental income. Patients are also better served through full-service centers.
2. Fill your schedule daily. Centers can only succeed by optimizing space and resources. "We know we have 51 slots per day to fill," Mr. Gleason says. "We average around 46 patient visits per day with many patients needing more than one procedure. We know how to fill those slots every day."
Centers which are not filling schedules daily should look to recruit more physicians to bring cases or should try to limit the hours the ASC is open.
The management at Berks has recruited reputable physicians, and the practice has grown from five physicians to 13 who bring all their cases to the surgery center. "Because of the surgery center and the forward-thinking business focus of the practice management, we are gaining cases frequently," he says.
3. Monitor payment rates and contracts. Though Medicare rates continue to decrease, GI ASCs should still work with commercial payors to negotiate decent contracts and keep patients accountable for payments.
Be proactive about constantly scrutinizing payment rates, Mr. Gleason says. Contracts can still be renegotiated for favorable rates that allow GI centers to stay profitable, even if payors push back. "We make an effort to be kept whole in any negotiations," he says. Don't accept rates that will cause your center to lose money.
Centers also need to be more aggressive in collecting payments than in years past when reimbursements were strong.
"We make efforts to reach out to patients to make sure they are aware of their responsibility," he says. "We have policies in place to ensure we are treating patients in a fair manner but also holding them accountable. We may not have been as on top of this seven years ago."
Dedicate some staff members to monitor accounts receivable and stay in touch with patients. Strive to collect as much money up front as possible to decrease time in between performing procedures and getting reimbursed. Mr. Gleason says your A/R staff can be successful while still being compassionate to patients' situations.
4. Engage physicians. GI ASCs will only be successful if the physicians are mentally and practically invested in making the center thrive. When given the opportunity to have a stake in the business operations, physicians will produce results.
"In my experience, surgery centers tend to run quite well when managed by a partnership of a proactive, business-savvy physician group and a management team geared toward making things work well for the physicians," Mr. Gleason says.
"[The physicians] know how they want things to run and can articulate that," he says. "They are very efficient at meeting both their needs and the needs of the community."
Rely on physician input to develop a patient-centered ASC that stresses high quality care. A mix of business-oriented and care-oriented physicians works well to meet needs on both sides of the spectrum.
Regardless of financial stake, the physicians need to be engaged and involved in the center and put pressure on each other.
"Whether the physicians are [financially] invested in the center or not, they are going to have the same drive to make the facility work as well as put parameters to hold everyone accountable," Mr. Gleason says. He also credits having a very strong physician leader on staff to keeping everyone on the same page.
5. Remain GI-focused. Trying to maintain successful GI services in addition to other surgery center specialties can lead to problems, Mr. Gleason says.
"With only GI physicians, we are able to know what we can fit and also be flexible with how we can fit those cases because we know what's available and who can do it," he says.
"If you mix GI in with other services, it gets too complicated to manage," he says, which can detract from efficiency, quality care and profits. Hospitals also provide less efficient GI services and are less likely to have specialty physicians in employ who only work with GI cases.
While there is a place for GI ASCs in the marketplace, Mr. Gleason predicts many centers will opt for forming joint ventures with hospitals.
"Hospitals are seeing these well-run centers and saying, 'Why would we break it up?'" he says. "They know they have a need for the services and a high volume of services so they partner."
Joint ventures can give GI physicians greater resources and ability to negotiate commercial payor contracts.
6. Team up with a management company. The physician owners at Berks work with a full-service management company to run their GI ASC, and Mr. Gleason says this can be a viable option for staying successful.
Look for a management company that is aware of what's going on in the world of GI regulation and legislation. He also recommends working with a company which provides assistance with billing, quality control, regulatory surveys, human resources, financial reporting and information systems.
"It's important to have a good partnership with people you can trust," he says. "You know they are going to bring value to your organization, something that is hard to do on your own as a solo GI practice."
Management companies will be looking to make a profit for themselves, but the ones to partner with will be striving for the "win-wins."
"They are very driven, very aggressively striving to benefit the practice and themselves," he says of Berks' management company. "The wins have very much come out as we've worked with them."
More Articles on GI:
Gastroenterologist on the Move: Dr. Burr Loew Joins GI Associates of New Hampshire
Kansas Gastroenterology Set to Relocate to Accommodate New Gastroenterologists
18 Statistics on Gastroenterology Compensation
But GI-driven ASCs can still successful, despite the financial squeeze. John Gleason, executive director of Berks Center for Digestive Health in Wyomissing, Pa., has been in the GI ASC field for 12 years. In that time, he has seen rates drop, but he has also developed ways to keep a center profitable and thriving.
Here are Mr. Gleason's six secrets for developing and sustaining a profitable GI ASC in just about any market.
1. Expand specialty services. Berks is constantly looking at expanding service options for GI patients, Mr. Gleason says. In the last five years, Berks has added a pathology lab for specimens taken at the surgery center and an infusion service.
The first year after the pathology lab opened, Berks kept its revenue steady despite reimbursement cuts. "Without the lab, we would have trouble maintaining," Mr. Gleason says.
He encourages surgery centers to always look toward adding GI-complimentary services such as hemorrhoid banding or PillCam bowel examination. These services can be simple to incorporate into an existing center and can bring supplemental income. Patients are also better served through full-service centers.
2. Fill your schedule daily. Centers can only succeed by optimizing space and resources. "We know we have 51 slots per day to fill," Mr. Gleason says. "We average around 46 patient visits per day with many patients needing more than one procedure. We know how to fill those slots every day."
Centers which are not filling schedules daily should look to recruit more physicians to bring cases or should try to limit the hours the ASC is open.
The management at Berks has recruited reputable physicians, and the practice has grown from five physicians to 13 who bring all their cases to the surgery center. "Because of the surgery center and the forward-thinking business focus of the practice management, we are gaining cases frequently," he says.
3. Monitor payment rates and contracts. Though Medicare rates continue to decrease, GI ASCs should still work with commercial payors to negotiate decent contracts and keep patients accountable for payments.
Be proactive about constantly scrutinizing payment rates, Mr. Gleason says. Contracts can still be renegotiated for favorable rates that allow GI centers to stay profitable, even if payors push back. "We make an effort to be kept whole in any negotiations," he says. Don't accept rates that will cause your center to lose money.
Centers also need to be more aggressive in collecting payments than in years past when reimbursements were strong.
"We make efforts to reach out to patients to make sure they are aware of their responsibility," he says. "We have policies in place to ensure we are treating patients in a fair manner but also holding them accountable. We may not have been as on top of this seven years ago."
Dedicate some staff members to monitor accounts receivable and stay in touch with patients. Strive to collect as much money up front as possible to decrease time in between performing procedures and getting reimbursed. Mr. Gleason says your A/R staff can be successful while still being compassionate to patients' situations.
4. Engage physicians. GI ASCs will only be successful if the physicians are mentally and practically invested in making the center thrive. When given the opportunity to have a stake in the business operations, physicians will produce results.
"In my experience, surgery centers tend to run quite well when managed by a partnership of a proactive, business-savvy physician group and a management team geared toward making things work well for the physicians," Mr. Gleason says.
"[The physicians] know how they want things to run and can articulate that," he says. "They are very efficient at meeting both their needs and the needs of the community."
Rely on physician input to develop a patient-centered ASC that stresses high quality care. A mix of business-oriented and care-oriented physicians works well to meet needs on both sides of the spectrum.
Regardless of financial stake, the physicians need to be engaged and involved in the center and put pressure on each other.
"Whether the physicians are [financially] invested in the center or not, they are going to have the same drive to make the facility work as well as put parameters to hold everyone accountable," Mr. Gleason says. He also credits having a very strong physician leader on staff to keeping everyone on the same page.
5. Remain GI-focused. Trying to maintain successful GI services in addition to other surgery center specialties can lead to problems, Mr. Gleason says.
"With only GI physicians, we are able to know what we can fit and also be flexible with how we can fit those cases because we know what's available and who can do it," he says.
"If you mix GI in with other services, it gets too complicated to manage," he says, which can detract from efficiency, quality care and profits. Hospitals also provide less efficient GI services and are less likely to have specialty physicians in employ who only work with GI cases.
While there is a place for GI ASCs in the marketplace, Mr. Gleason predicts many centers will opt for forming joint ventures with hospitals.
"Hospitals are seeing these well-run centers and saying, 'Why would we break it up?'" he says. "They know they have a need for the services and a high volume of services so they partner."
Joint ventures can give GI physicians greater resources and ability to negotiate commercial payor contracts.
6. Team up with a management company. The physician owners at Berks work with a full-service management company to run their GI ASC, and Mr. Gleason says this can be a viable option for staying successful.
Look for a management company that is aware of what's going on in the world of GI regulation and legislation. He also recommends working with a company which provides assistance with billing, quality control, regulatory surveys, human resources, financial reporting and information systems.
"It's important to have a good partnership with people you can trust," he says. "You know they are going to bring value to your organization, something that is hard to do on your own as a solo GI practice."
Management companies will be looking to make a profit for themselves, but the ones to partner with will be striving for the "win-wins."
"They are very driven, very aggressively striving to benefit the practice and themselves," he says of Berks' management company. "The wins have very much come out as we've worked with them."
More Articles on GI:
Gastroenterologist on the Move: Dr. Burr Loew Joins GI Associates of New Hampshire
Kansas Gastroenterology Set to Relocate to Accommodate New Gastroenterologists
18 Statistics on Gastroenterology Compensation