More orthopedic and spine procedures are now able to move into the outpatient surgery center setting. Ambulatory surgery centers across the country are looking to bring these high acuity cases in and courting orthopedic surgeons who may be future partners.
"Orthopedics plays a very large piece of our margin," says Charles Dailey, vice president of development at ASD Management. "They are usually the drivers of business. As business fluctuates, we want to keep our eye on the ball and we are always looking for new and attractive ways to bring in an orthopedic surgeon and create a comfortable environment."
Here are 10 steps for administrators to successfully recruit the right orthopedic and spine surgeons for their centers.
1. Identify surgeons with high volume outpatient procedures. The most important surgeons to target are those who have a high volume of potentially outpatient procedures such as arthroscopy, hand or foot surgery and discectomies. Some surgeons are also performing anterior cervical decompressions and fusions in ASCs as well.
"I would look for orthopedic surgeons who have within their practices a significant percentage of surgeries that are appropriate for outpatient surgery centers," says John McConnell, MD, an orthopedic surgeon in Greenville, Texas. "These surgeons tend to be typical candidates for surgical center staff as opposed to physicians whose practices involve total joint replacement or trauma surgeons who work in the hospital environment."
If the surgeons don't currently do outpatient procedures but are interested in the surgery center, offer to work with them to bring new procedures into the ASC. For example, surgeons can perform a percutaneous osteotomy to remove scar tissue from damaged tendons or lateral epicondylitis for tennis elbow.
"Surgeons can go in and perform this procedure to repair someone who is suffering from tennis elbow," says Mr. Dailey. "The procedure is beneficial for patients and a marketing tool for surgery centers because there are many people who need that procedure. It's a real opportunity — we don't just want to say surgeons come here because their patients will do the best; we are also taking into consideration who the surgeons are and where they want to grow their practice. We have a focus on untapped markets and populations for the future."
2. Emphasize the culture difference from hospitals. Ambulatory surgery centers often build a different culture than hospital departments, and for some orthopedic surgeons this will be an important selling point. Surgery centers are built around optimizing efficiency, patient satisfaction and service to the physicians.
"The central feature for surgery centers is to sell itself to the orthopedic surgeon by emphasizing the differences between the surgery center culture and the hospital culture," says Dr. McConnell. "The efficiency of time utilization in a surgery center is invariably distinctly better than in a hospital and this has got to be emphasized to physicians from the standpoint of patient customer service."
Surgery centers also boast a simpler check-in and check-out process and a higher level of personal attention. ASC administrators are readily available for surgeons and flexible to meet their needs while hospital leaders have several constituencies to negotiate and process changes are bogged down by bureaucracy.
"Distinguish what is different in the culture and in the handling of patients and surgeons in the surgery center as opposed to the hospital," says Dr. McConnell. "In the surgical center, there is more of a team approach and the physician himself is more of a team. He or she has to view themselves as a team member and you generally have very accommodating people who function in the ASC as a team and work from case to case to case. It's less of an authoritarian bureaucratic approach than the hospital."
3. Give a tour of your facility. Your first meeting with the surgeon might be at their office so you can learn about their practice, the type of cases they do and what they are looking for in an ASC. If the meeting goes well, invite the surgeon for a tour of your facility.
"During the tour, there should be other orthopedic and spine surgeons and anesthesiologists to talk to the candidate," says Reed Martin, COO of Surgical Management Professionals. "During that tour you can identify the equipment, supply and implant needs of the surgeon. They are quite often different from other specialists that are at the surgery center. You also want to get a feel for the kind of case volume potential the surgeon has because there are significant costs associated with adding surgeons or service lines."
During the tour, also mention block time possibilities and discuss additional training for the staff to prepare for orthopedic cases. If the surgeon wants to perform more complex cases that would require a 23 hour stay, decide whether that would fall within the mission and vision of your surgery center from a cost perspective.
4. Provide a one-page statement about the ASC. An easy way for the surgeon to quickly assess whether an ASC would be a good fit is by laying out the facts in a one-page statement. The statement should identify the strengths of the facility and potential for investment opportunities. The statement can be utilized either on the tour or the visit to the surgeon's office.
"The surgeon will want to know what your turnover time is, the experience of your staff on these kinds of cases and what vendors you work with," says Mr. Martin. "Implants are very important for these surgeons and the ability to acquire specific implants they need may be very critical."
The statement can also include information about infection control, complication rates and patient satisfaction scores.
5. Offer a team of dedicated staff to the surgeon. When surgeons take cases to a hospital operating room, they may have a different surgical team from one day to the next, or even from one case to another. Surgery centers are a smaller environment with a more focused staff, which means they can provide the same staff members for every case a single surgeon does.
This consistency promotes efficiency and comfort for surgeons because they know their staff members are experienced and familiar with their technique.
"One of the most important features in the surgery center is surgeons tend to have a dedicated staff who are there on a recurring basis doing cases they identify with and know well as compared to the general hospital experience in which the surgical and technical crew rotate through," says Dr. McConnell. "At the hospital, these crews aren't doing repetitions of surgical cases. Consistency is very important for improving quality."
6. Have newer equipment available. Orthopedic surgeons are seeing an ever-evolving field of surgical equipment, instrumentation and technique. Often, the surgeon's hospital department is passed over for the newest equipment in favor of initiatives in other departments or service lines. If your surgery center has more up-to-date equipment — or would be willing to purchase new equipment if the surgeon came on board — the center becomes more attractive.
"There is often newer and better equipment for outpatient surgery," says Dr. McConnell. "Procurement of equipment is also easier and better in the surgery center."
7. Highlight benefits for patient care. There are several qualities of the surgery center that allow orthopedic and spine surgeons to provide better care for patients. Surgery centers generally have a lower infection rate than hospitals, and since patients are moved through within 23 hours there aren't any "sick" patients to infect otherwise healthy orthopedic patients.
Surgery centers also aim to reduce wait times and provide more individualized attention to patients in an effort to increase patient satisfaction.
"Encourage surgeons to use your surgery center instead of competing hospitals or ASCs by convincing them their patients will have better service, more attentive staff and better surgical equipment," says Dr. McConnell. "The collegial environment in the surgery center is also attractive to surgeons and allows them to trust ASC staff with their patients."
8. Help the surgeons grow their business. When approaching orthopedic and spine surgeons, offer ways to help them build their business. Identify emerging medical markets and figure out how you can help the surgeons develop these opportunities to potentially bring cases into your center.
"We have a lot of osteoporosis and overweight people in the world, which leads to compression fractures," says Mr. Dailey. "There are a lot of compression fractures out there and those patients need treatment options. We can guide surgeons to offer support programs that encourage DEXA screenings and work with internal medicine facilities to identify when it would be appropriate to send their patients to orthopedic and spine specialists."
Surgery centers can work with their surgeons to spread education about their practices and make operating room time available for those cases.
"We aren't just raising awareness about our surgeons, we are creating a market and a pathway for patients who really need to be treated," says Mr. Dailey. "We are using medicine as a driver for our markets. This is well received in the orthopedic community and we are doing procedures in surgery centers with surgeons who are interested in practice growth."
9. Allow a no-pressure trial period for surgeons to test cases. Before surgeons decide whether they want to bring cases into the surgery center on a permanent basis, and even invest in the surgery center in the future, allow them a trial period where they can bring a few cases into the ASC and see whether the environment will be a good match for them.
"We want to see whether the surgeon will fit in the surgery center by doing a few trial cases," says Dr. McConnell. "What I've done with a new ASC is book a single case and have shake down crews so the surgeons can do a few cases in a non-pressure situation before we begin to ramp up and do significant volume. A break-in period with a few cases is always worthwhile."
During this time the surgery center administrator and owners can examine whether the new surgeon will have the right qualities and characteristics to perform outpatient cases there. "It's important for the surgeon to use the facility for a while and see if they like it," says Mr. Martin. "They should see if the implant selection and staff fits their needs."
10. Present investment opportunities in the future. When the surgeon is serious about bringing cases into the surgery center, presenting a potential investment opportunity may seal the deal. Surgeons are looking for new investment opportunities to enhance their revenue, and if they fit within the surgery center's structure they could be a valuable partner in the future.
However, make it clear that the surgeon must go through the trial period before making an investment.
"Surgery centers want to see efficient surgeons that follow policies and procedures and provide high quality outcomes," says Mr. Martin. "If there is a good fit for a number of months, investment can further be discussed."
More Articles on Surgery Centers:
7 Steps to Bring Spine Cases Into an ASC
How ASCs Can Become a Disruptive Force in the Healthcare Market: Q&A With Adam Powell
5 Goals for Surgery Centers in 2013
"Orthopedics plays a very large piece of our margin," says Charles Dailey, vice president of development at ASD Management. "They are usually the drivers of business. As business fluctuates, we want to keep our eye on the ball and we are always looking for new and attractive ways to bring in an orthopedic surgeon and create a comfortable environment."Here are 10 steps for administrators to successfully recruit the right orthopedic and spine surgeons for their centers.
1. Identify surgeons with high volume outpatient procedures. The most important surgeons to target are those who have a high volume of potentially outpatient procedures such as arthroscopy, hand or foot surgery and discectomies. Some surgeons are also performing anterior cervical decompressions and fusions in ASCs as well.
"I would look for orthopedic surgeons who have within their practices a significant percentage of surgeries that are appropriate for outpatient surgery centers," says John McConnell, MD, an orthopedic surgeon in Greenville, Texas. "These surgeons tend to be typical candidates for surgical center staff as opposed to physicians whose practices involve total joint replacement or trauma surgeons who work in the hospital environment."
If the surgeons don't currently do outpatient procedures but are interested in the surgery center, offer to work with them to bring new procedures into the ASC. For example, surgeons can perform a percutaneous osteotomy to remove scar tissue from damaged tendons or lateral epicondylitis for tennis elbow.
"Surgeons can go in and perform this procedure to repair someone who is suffering from tennis elbow," says Mr. Dailey. "The procedure is beneficial for patients and a marketing tool for surgery centers because there are many people who need that procedure. It's a real opportunity — we don't just want to say surgeons come here because their patients will do the best; we are also taking into consideration who the surgeons are and where they want to grow their practice. We have a focus on untapped markets and populations for the future."
2. Emphasize the culture difference from hospitals. Ambulatory surgery centers often build a different culture than hospital departments, and for some orthopedic surgeons this will be an important selling point. Surgery centers are built around optimizing efficiency, patient satisfaction and service to the physicians.
"The central feature for surgery centers is to sell itself to the orthopedic surgeon by emphasizing the differences between the surgery center culture and the hospital culture," says Dr. McConnell. "The efficiency of time utilization in a surgery center is invariably distinctly better than in a hospital and this has got to be emphasized to physicians from the standpoint of patient customer service."
Surgery centers also boast a simpler check-in and check-out process and a higher level of personal attention. ASC administrators are readily available for surgeons and flexible to meet their needs while hospital leaders have several constituencies to negotiate and process changes are bogged down by bureaucracy.
"Distinguish what is different in the culture and in the handling of patients and surgeons in the surgery center as opposed to the hospital," says Dr. McConnell. "In the surgical center, there is more of a team approach and the physician himself is more of a team. He or she has to view themselves as a team member and you generally have very accommodating people who function in the ASC as a team and work from case to case to case. It's less of an authoritarian bureaucratic approach than the hospital."
3. Give a tour of your facility. Your first meeting with the surgeon might be at their office so you can learn about their practice, the type of cases they do and what they are looking for in an ASC. If the meeting goes well, invite the surgeon for a tour of your facility.
"During the tour, there should be other orthopedic and spine surgeons and anesthesiologists to talk to the candidate," says Reed Martin, COO of Surgical Management Professionals. "During that tour you can identify the equipment, supply and implant needs of the surgeon. They are quite often different from other specialists that are at the surgery center. You also want to get a feel for the kind of case volume potential the surgeon has because there are significant costs associated with adding surgeons or service lines."During the tour, also mention block time possibilities and discuss additional training for the staff to prepare for orthopedic cases. If the surgeon wants to perform more complex cases that would require a 23 hour stay, decide whether that would fall within the mission and vision of your surgery center from a cost perspective.
4. Provide a one-page statement about the ASC. An easy way for the surgeon to quickly assess whether an ASC would be a good fit is by laying out the facts in a one-page statement. The statement should identify the strengths of the facility and potential for investment opportunities. The statement can be utilized either on the tour or the visit to the surgeon's office.
"The surgeon will want to know what your turnover time is, the experience of your staff on these kinds of cases and what vendors you work with," says Mr. Martin. "Implants are very important for these surgeons and the ability to acquire specific implants they need may be very critical."
The statement can also include information about infection control, complication rates and patient satisfaction scores.
5. Offer a team of dedicated staff to the surgeon. When surgeons take cases to a hospital operating room, they may have a different surgical team from one day to the next, or even from one case to another. Surgery centers are a smaller environment with a more focused staff, which means they can provide the same staff members for every case a single surgeon does.
This consistency promotes efficiency and comfort for surgeons because they know their staff members are experienced and familiar with their technique.
"One of the most important features in the surgery center is surgeons tend to have a dedicated staff who are there on a recurring basis doing cases they identify with and know well as compared to the general hospital experience in which the surgical and technical crew rotate through," says Dr. McConnell. "At the hospital, these crews aren't doing repetitions of surgical cases. Consistency is very important for improving quality."
6. Have newer equipment available. Orthopedic surgeons are seeing an ever-evolving field of surgical equipment, instrumentation and technique. Often, the surgeon's hospital department is passed over for the newest equipment in favor of initiatives in other departments or service lines. If your surgery center has more up-to-date equipment — or would be willing to purchase new equipment if the surgeon came on board — the center becomes more attractive.
"There is often newer and better equipment for outpatient surgery," says Dr. McConnell. "Procurement of equipment is also easier and better in the surgery center."
7. Highlight benefits for patient care. There are several qualities of the surgery center that allow orthopedic and spine surgeons to provide better care for patients. Surgery centers generally have a lower infection rate than hospitals, and since patients are moved through within 23 hours there aren't any "sick" patients to infect otherwise healthy orthopedic patients.
Surgery centers also aim to reduce wait times and provide more individualized attention to patients in an effort to increase patient satisfaction.
"Encourage surgeons to use your surgery center instead of competing hospitals or ASCs by convincing them their patients will have better service, more attentive staff and better surgical equipment," says Dr. McConnell. "The collegial environment in the surgery center is also attractive to surgeons and allows them to trust ASC staff with their patients."
8. Help the surgeons grow their business. When approaching orthopedic and spine surgeons, offer ways to help them build their business. Identify emerging medical markets and figure out how you can help the surgeons develop these opportunities to potentially bring cases into your center.
"We have a lot of osteoporosis and overweight people in the world, which leads to compression fractures," says Mr. Dailey. "There are a lot of compression fractures out there and those patients need treatment options. We can guide surgeons to offer support programs that encourage DEXA screenings and work with internal medicine facilities to identify when it would be appropriate to send their patients to orthopedic and spine specialists."
Surgery centers can work with their surgeons to spread education about their practices and make operating room time available for those cases.
"We aren't just raising awareness about our surgeons, we are creating a market and a pathway for patients who really need to be treated," says Mr. Dailey. "We are using medicine as a driver for our markets. This is well received in the orthopedic community and we are doing procedures in surgery centers with surgeons who are interested in practice growth."
9. Allow a no-pressure trial period for surgeons to test cases. Before surgeons decide whether they want to bring cases into the surgery center on a permanent basis, and even invest in the surgery center in the future, allow them a trial period where they can bring a few cases into the ASC and see whether the environment will be a good match for them.
"We want to see whether the surgeon will fit in the surgery center by doing a few trial cases," says Dr. McConnell. "What I've done with a new ASC is book a single case and have shake down crews so the surgeons can do a few cases in a non-pressure situation before we begin to ramp up and do significant volume. A break-in period with a few cases is always worthwhile."
During this time the surgery center administrator and owners can examine whether the new surgeon will have the right qualities and characteristics to perform outpatient cases there. "It's important for the surgeon to use the facility for a while and see if they like it," says Mr. Martin. "They should see if the implant selection and staff fits their needs."
10. Present investment opportunities in the future. When the surgeon is serious about bringing cases into the surgery center, presenting a potential investment opportunity may seal the deal. Surgeons are looking for new investment opportunities to enhance their revenue, and if they fit within the surgery center's structure they could be a valuable partner in the future.
However, make it clear that the surgeon must go through the trial period before making an investment.
"Surgery centers want to see efficient surgeons that follow policies and procedures and provide high quality outcomes," says Mr. Martin. "If there is a good fit for a number of months, investment can further be discussed."
More Articles on Surgery Centers:
7 Steps to Bring Spine Cases Into an ASC
How ASCs Can Become a Disruptive Force in the Healthcare Market: Q&A With Adam Powell
5 Goals for Surgery Centers in 2013