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Ambulatory surgery centers 101: What new GIs need to know
Almost 20 years ago, I joined Digestive Disease Specialists in Oklahoma, where I am an owner in two ambulatory endoscopy centers (AECs). Through this experience, I’ve learned a thing or two about the advantages of these centers and what to consider when joining a practice that has ownership in an endoscopy center or an ambulatory surgery center (ASC).
ASCs – or in my case AECs – are highly specialized, modern health care facilities in which physicians provide safe, high-quality procedures to millions of Americans each year, including diagnostic and preventive procedures. ASCs and AECs allow us to provide a more convenient and cost-effective alternative to performing GI procedures in a hospital. As you can imagine, these facilities are a vital part of being an independent gastroenterologist.
Quality care at a lower cost
When looking into practices with ownership in surgery centers, quality of care is one of the most critical considerations. Each center must enter into an agreement with Medicare and meet its certification requirements, which are similar to those required for hospital outpatient departments. We also undergo accreditation by the Accreditation Association for Ambulatory Healthcare. And while not everyone participates in quality registries such as GIquic – which helps us define and refine our endoscopic outcomes – our AEC does because we put patient care first.
This focus on quality leads to better care. A 2016 study of Medicare claims in the Journal of Health Economics shows that ASCs and AECs, on average, provide higher-quality care for outpatient procedures than hospitals.1
We get into medicine because we care about patients and want to provide them with the best and most convenient care possible. Because we don’t have to operate in the context of a large hospital, we can be nimbler when it comes to patient needs. As is true in other areas, the more you specialize, the more effective and efficient you can become performing certain procedures. For instance, our practice is highly specialized in endoscopy. As a result, we can be highly efficient in the turnaround time in between patient procedures. This helps people get back to their daily lives as soon as possible, whereas patients may spend a lot more time waiting to have their procedure in the hospital setting.
Performing procedures in an ASC or AEC also helps us keep costs down, and we spend a lot of time educating policymakers about the role independent physicians play in lowering health care costs. According to a recent study in Health Affairs, hospital-based outpatient care prices grew at four times the rate of physician prices from 2007 to 2014.2 And the National Institute for Health Care Reform found that the average Medicare facility payment for a basic colonoscopy was more than twice as much in a hospital setting.3
The challenges and benefits of running an ASC or AEC
With consolidation of hospitals and insurance companies, operating an independent ASC or AEC has become more challenging. The players are bigger, providing more competition. Where we practice in Oklahoma, we are the only independent gastroenterologists. The way we have kept up is by diversifying the ancillary services we offer. This includes infusion center services, pathology, anesthesia, and research alongside our standard endoscopic and office/hospital-based practice.
As doctors, we are not typically trained on the business side of medicine, but when you own an ASC, you need to learn to be your own boss. You will need to understand the details of how the business operates, from relevant state and federal regulations to the supportive services that make the center run smoothly.
Gastroenterologists who are new to the field can and should ask questions of any practice they are considering joining about the buy-in process for ASCs and the path to becoming a partner. One of the things to consider is what kind of planning has gone into determining how many investors there are in the ASC. It is possible to have too many physician partners, but having too few could also present challenges. If there are too many physician owners, ownership interests could be diluted. On the flip side, if there aren’t many physician owners, it will be more expensive to buy in and there will be greater risk.
Another question to ask is if the practice partners with a hospital for its ASC or AEC. About one in four surgery centers have a hospital partner. This can be helpful with managed care contracting and concerns physicians may have about being excluded from having hospital privileges. Partnering with a hospital is not an indication of a successful center given there are still many surgery centers with hospital partners that are not run well or underperform.
While I have outlined some of the challenges of owning an ASC or AEC, physician ownership can be very attractive under the right circumstances. There are many benefits including having more control over your life. You get to set your own schedules and determine your patient load.
When physicians own the surgery center, we can control the schedule and the environment in the operating room. In a hospital, there is not much we can do if the operating room is not running efficiently. If our cases are bumped, the care of our patients is undermined. In our own surgery center, we can ensure that these things do not happen. We are able to provide our patients the best care possible.
When I look back over my time in our AEC, I wouldn’t change anything. Even though there may be challenges in running an AEC, I would advise young gastroenterologists to consider this path. Nothing worthwhile is easy, but the ability to provide the best care to our patients is its own reward.
References
1. Munnich E et al. J Health Economics, January 2018;57:147-67. https://doi.org/10.1016/j.jhealeco.2017.11.004.
2. Cooper Z et al. https://doi.org/10.1377/hlthaff.2018.05424. Health Affairs 2019;38(2).
3. Reschovsky J et al. NIHCR Research Brief No. 16. http://nihcr.org/wp-content/uploads/2016/07/Research_Brief_No._16.pdf. National Institute for Health Care Reform; June 2014.
Dr. Stokesberry is a practicing gastroenterologist at Digestive Disease Specialists in Oklahoma City and serves as an executive committee member of the Digestive Health Physicians Association.
Almost 20 years ago, I joined Digestive Disease Specialists in Oklahoma, where I am an owner in two ambulatory endoscopy centers (AECs). Through this experience, I’ve learned a thing or two about the advantages of these centers and what to consider when joining a practice that has ownership in an endoscopy center or an ambulatory surgery center (ASC).
ASCs – or in my case AECs – are highly specialized, modern health care facilities in which physicians provide safe, high-quality procedures to millions of Americans each year, including diagnostic and preventive procedures. ASCs and AECs allow us to provide a more convenient and cost-effective alternative to performing GI procedures in a hospital. As you can imagine, these facilities are a vital part of being an independent gastroenterologist.
Quality care at a lower cost
When looking into practices with ownership in surgery centers, quality of care is one of the most critical considerations. Each center must enter into an agreement with Medicare and meet its certification requirements, which are similar to those required for hospital outpatient departments. We also undergo accreditation by the Accreditation Association for Ambulatory Healthcare. And while not everyone participates in quality registries such as GIquic – which helps us define and refine our endoscopic outcomes – our AEC does because we put patient care first.
This focus on quality leads to better care. A 2016 study of Medicare claims in the Journal of Health Economics shows that ASCs and AECs, on average, provide higher-quality care for outpatient procedures than hospitals.1
We get into medicine because we care about patients and want to provide them with the best and most convenient care possible. Because we don’t have to operate in the context of a large hospital, we can be nimbler when it comes to patient needs. As is true in other areas, the more you specialize, the more effective and efficient you can become performing certain procedures. For instance, our practice is highly specialized in endoscopy. As a result, we can be highly efficient in the turnaround time in between patient procedures. This helps people get back to their daily lives as soon as possible, whereas patients may spend a lot more time waiting to have their procedure in the hospital setting.
Performing procedures in an ASC or AEC also helps us keep costs down, and we spend a lot of time educating policymakers about the role independent physicians play in lowering health care costs. According to a recent study in Health Affairs, hospital-based outpatient care prices grew at four times the rate of physician prices from 2007 to 2014.2 And the National Institute for Health Care Reform found that the average Medicare facility payment for a basic colonoscopy was more than twice as much in a hospital setting.3
The challenges and benefits of running an ASC or AEC
With consolidation of hospitals and insurance companies, operating an independent ASC or AEC has become more challenging. The players are bigger, providing more competition. Where we practice in Oklahoma, we are the only independent gastroenterologists. The way we have kept up is by diversifying the ancillary services we offer. This includes infusion center services, pathology, anesthesia, and research alongside our standard endoscopic and office/hospital-based practice.
As doctors, we are not typically trained on the business side of medicine, but when you own an ASC, you need to learn to be your own boss. You will need to understand the details of how the business operates, from relevant state and federal regulations to the supportive services that make the center run smoothly.
Gastroenterologists who are new to the field can and should ask questions of any practice they are considering joining about the buy-in process for ASCs and the path to becoming a partner. One of the things to consider is what kind of planning has gone into determining how many investors there are in the ASC. It is possible to have too many physician partners, but having too few could also present challenges. If there are too many physician owners, ownership interests could be diluted. On the flip side, if there aren’t many physician owners, it will be more expensive to buy in and there will be greater risk.
Another question to ask is if the practice partners with a hospital for its ASC or AEC. About one in four surgery centers have a hospital partner. This can be helpful with managed care contracting and concerns physicians may have about being excluded from having hospital privileges. Partnering with a hospital is not an indication of a successful center given there are still many surgery centers with hospital partners that are not run well or underperform.
While I have outlined some of the challenges of owning an ASC or AEC, physician ownership can be very attractive under the right circumstances. There are many benefits including having more control over your life. You get to set your own schedules and determine your patient load.
When physicians own the surgery center, we can control the schedule and the environment in the operating room. In a hospital, there is not much we can do if the operating room is not running efficiently. If our cases are bumped, the care of our patients is undermined. In our own surgery center, we can ensure that these things do not happen. We are able to provide our patients the best care possible.
When I look back over my time in our AEC, I wouldn’t change anything. Even though there may be challenges in running an AEC, I would advise young gastroenterologists to consider this path. Nothing worthwhile is easy, but the ability to provide the best care to our patients is its own reward.
References
1. Munnich E et al. J Health Economics, January 2018;57:147-67. https://doi.org/10.1016/j.jhealeco.2017.11.004.
2. Cooper Z et al. https://doi.org/10.1377/hlthaff.2018.05424. Health Affairs 2019;38(2).
3. Reschovsky J et al. NIHCR Research Brief No. 16. http://nihcr.org/wp-content/uploads/2016/07/Research_Brief_No._16.pdf. National Institute for Health Care Reform; June 2014.
Dr. Stokesberry is a practicing gastroenterologist at Digestive Disease Specialists in Oklahoma City and serves as an executive committee member of the Digestive Health Physicians Association.
Almost 20 years ago, I joined Digestive Disease Specialists in Oklahoma, where I am an owner in two ambulatory endoscopy centers (AECs). Through this experience, I’ve learned a thing or two about the advantages of these centers and what to consider when joining a practice that has ownership in an endoscopy center or an ambulatory surgery center (ASC).
ASCs – or in my case AECs – are highly specialized, modern health care facilities in which physicians provide safe, high-quality procedures to millions of Americans each year, including diagnostic and preventive procedures. ASCs and AECs allow us to provide a more convenient and cost-effective alternative to performing GI procedures in a hospital. As you can imagine, these facilities are a vital part of being an independent gastroenterologist.
Quality care at a lower cost
When looking into practices with ownership in surgery centers, quality of care is one of the most critical considerations. Each center must enter into an agreement with Medicare and meet its certification requirements, which are similar to those required for hospital outpatient departments. We also undergo accreditation by the Accreditation Association for Ambulatory Healthcare. And while not everyone participates in quality registries such as GIquic – which helps us define and refine our endoscopic outcomes – our AEC does because we put patient care first.
This focus on quality leads to better care. A 2016 study of Medicare claims in the Journal of Health Economics shows that ASCs and AECs, on average, provide higher-quality care for outpatient procedures than hospitals.1
We get into medicine because we care about patients and want to provide them with the best and most convenient care possible. Because we don’t have to operate in the context of a large hospital, we can be nimbler when it comes to patient needs. As is true in other areas, the more you specialize, the more effective and efficient you can become performing certain procedures. For instance, our practice is highly specialized in endoscopy. As a result, we can be highly efficient in the turnaround time in between patient procedures. This helps people get back to their daily lives as soon as possible, whereas patients may spend a lot more time waiting to have their procedure in the hospital setting.
Performing procedures in an ASC or AEC also helps us keep costs down, and we spend a lot of time educating policymakers about the role independent physicians play in lowering health care costs. According to a recent study in Health Affairs, hospital-based outpatient care prices grew at four times the rate of physician prices from 2007 to 2014.2 And the National Institute for Health Care Reform found that the average Medicare facility payment for a basic colonoscopy was more than twice as much in a hospital setting.3
The challenges and benefits of running an ASC or AEC
With consolidation of hospitals and insurance companies, operating an independent ASC or AEC has become more challenging. The players are bigger, providing more competition. Where we practice in Oklahoma, we are the only independent gastroenterologists. The way we have kept up is by diversifying the ancillary services we offer. This includes infusion center services, pathology, anesthesia, and research alongside our standard endoscopic and office/hospital-based practice.
As doctors, we are not typically trained on the business side of medicine, but when you own an ASC, you need to learn to be your own boss. You will need to understand the details of how the business operates, from relevant state and federal regulations to the supportive services that make the center run smoothly.
Gastroenterologists who are new to the field can and should ask questions of any practice they are considering joining about the buy-in process for ASCs and the path to becoming a partner. One of the things to consider is what kind of planning has gone into determining how many investors there are in the ASC. It is possible to have too many physician partners, but having too few could also present challenges. If there are too many physician owners, ownership interests could be diluted. On the flip side, if there aren’t many physician owners, it will be more expensive to buy in and there will be greater risk.
Another question to ask is if the practice partners with a hospital for its ASC or AEC. About one in four surgery centers have a hospital partner. This can be helpful with managed care contracting and concerns physicians may have about being excluded from having hospital privileges. Partnering with a hospital is not an indication of a successful center given there are still many surgery centers with hospital partners that are not run well or underperform.
While I have outlined some of the challenges of owning an ASC or AEC, physician ownership can be very attractive under the right circumstances. There are many benefits including having more control over your life. You get to set your own schedules and determine your patient load.
When physicians own the surgery center, we can control the schedule and the environment in the operating room. In a hospital, there is not much we can do if the operating room is not running efficiently. If our cases are bumped, the care of our patients is undermined. In our own surgery center, we can ensure that these things do not happen. We are able to provide our patients the best care possible.
When I look back over my time in our AEC, I wouldn’t change anything. Even though there may be challenges in running an AEC, I would advise young gastroenterologists to consider this path. Nothing worthwhile is easy, but the ability to provide the best care to our patients is its own reward.
References
1. Munnich E et al. J Health Economics, January 2018;57:147-67. https://doi.org/10.1016/j.jhealeco.2017.11.004.
2. Cooper Z et al. https://doi.org/10.1377/hlthaff.2018.05424. Health Affairs 2019;38(2).
3. Reschovsky J et al. NIHCR Research Brief No. 16. http://nihcr.org/wp-content/uploads/2016/07/Research_Brief_No._16.pdf. National Institute for Health Care Reform; June 2014.
Dr. Stokesberry is a practicing gastroenterologist at Digestive Disease Specialists in Oklahoma City and serves as an executive committee member of the Digestive Health Physicians Association.