Fast forward to 2008 and the majority of clients I work with through my company (ASC Strategies) are surgery centers that are owned by a partnership of hospitals and physicians. While we are engaged to help them work through operational issues or to find opportunities for increased profitability, for the most part they are already successful partnerships. They are just looking for a third party to give them a little advice and direction.
As the number of these physician/hospital partnerships continues to grow, it is worthwhile to examine what this joining of two different cultures means for all of the parties affected and understand why a partnership with a hospital might be worth exploring for your ASC.
Patients
While the patients like the efficiency and friendliness of having their procedures in a freestanding surgery center, they seem to have an increased sense of comfort knowing there is a connection to the main hospital campus. Whether it is perception or reality (since all freestanding ASCs have the capacity for transfer to a hospital if needed), patients and their families like knowing the hospital — with both its reputation and all of its emergency equipment — is standing behind the services offered at the surgery center. Also, if the partnership is working, there is the opportunity for less duplication of outpatient surgical services and the expenses that accompany it; this reduces healthcare costs and allows the hospital to possibly add more complex services that can benefit the community.
Staff
One of the hardest groups to let go of the past and understand these partnerships is the employees that work in the surgery center. Many of them still hold on to the “us vs. them” mentality that has been the hallmark of relationships between the physicians and the hospital, especially if the employee has a long history working for one or the other partner. They have to be encouraged to remember that everyone is now on the same team. Not the hospital team or surgeon team, but the surgery center team.
Soon they see that having a hospital as a partner can facilitate sharing of equipment, supplies etc. And when you have physicians who are owners, they tend to start their cases on time and move cases through more quickly with fewer demands placed on the staff.
Surgeons
Even though some physicians come to these partnerships kicking and screaming, many surgeons who have had the opportunity to participate in a partnership with the hospital through a surgery center are pleased with the relationship. It is universal that most surgeons do not want the hospital administration to manage the center, but they do understand the value that the hospital administrator’s healthcare management expertise and clout with vendors and payors can bring to the surgery center. The biggest hurdle that the surgeons need to get over is exactly how much control the hospital will have over the operations of the center. If this issue is discussed early and honestly, we often see little conflict in making everyone comfortable with the roles.
Hospitals
It used to be a very hard sell to convince a hospital CFO that it is smart business for the hospital to support moving surgical cases into a lower reimbursing facility and split the revenue with surgeons performing the cases. But more and more sophisticated hospital leaders understand the value of partnering with their physicians in outpatient surgery centers, both as a way of solidifying relationships and decreasing expenses. The hospital administrators of successful joint-ventured surgery centers understand that they can be more successful in the long run when they partner with their surgeons instead of competing with them.
Hospital leaders across the country are now aggressively trying to find ways to partner with their medical staff in outpatient surgical ventures. Whether it is buying into existing physician-owned centers or opening new surgery centers and surgical hospitals in partnership with their physicians, it is rare to find a hospital or hospital system without some sort of joint-venture initiative in their strategic plan.
A scenario that can benefit all parties
From the early days of the surgery center industry, the main reason the surgeons took money out of their pockets to invest in a surgery center was not for a large return, but to create a more efficient and surgeon-friendly surgical environment to work in. With the changes in reimbursement, the need to see more patients and the tightening of available capital, that is even more the case today. Surgeons need an efficient place to work and hospitals need a lower cost environment for those cases which are seeing their reimbursement shrinking. One of the best models for everyone, (patient, staff, surgeon and hospital) is a surgery center where everyone is working together, honestly, and contributing their individual and diverse strengths to partnership and where everyone works to keep the interest of the partnership and the patients before their own.
Ms. Nantz (jnantz@ascstrategies.com) is co-founder of ASC Strategies, a privately-held ASC consulting company that works with hospitals, physicians and other professionals to help them develop and operate surgery centers. Learn more at www.ascstrategies.com.