5 Steps for Physician Owners to Make Spine Specialty ASCs Flourish

Donald Johnson, MD, has owned and practiced at Southeastern Spine Institute in Mount Pleasant, S.C., for nearly 24 years. In the last five years, he added an ambulatory surgery center. The practice now includes 10 physicians, 13 physician assistants and 156 employees. As many ASCs have joined with outside partners or brought on multiple specialties, Southeastern Spine has remained solely spine-focused.

Here are Dr. Johnson's five tips for succeeding as a single-specialty, physician-owned ASC.

1. Look for patients from a wide geographic area. When practicing within a single specialty, physicians may want to expand their potential patient pool by looking outside of their immediate geographic area.

"Half of our patients come 150 miles away or more to see us," Dr. Johnson says.

Look for ways to reach patients who live farther away can keep an ASC's patient base from being affected by market fluctuations, other practices opening up and any unforeseen variables.

2. Provide the most efficient patient care. Having patients travel long distances, though, puts the burden on a surgery center to provide comprehensive, efficient care.

"The ASC is important to us. It creates convenience for the patient," Dr. Johnson says. "It's not realistic to say to them, 'You need an injection or a nerve root block or surgery that we'll schedule 10 days from now. Try to get back up here.'"

Dr. Johnson's surgery center is open five days a week and fully staffed. He also builds openings into the schedule for patients who come from out of town and need specific care immediately.

Medical efficiency shouldn't just entail medical records and finances, he says. Efficient patient care is the way of the future.

"We can't make patients wait a month to get an MRI and then another month to get an EMG," he says. "In a place like ours, the goal is to do it all in one day."

3. Include pain management procedures. Look for revenue-generating activities within a specialty, such as adding imaging or complimentary procedures.

Single-specialty spine centers can incorporate pain management procedures as an additional source of service and revenue without straying from the spine focus. The Southeastern Spine Institute performs approximately 1,200 pain procedures a month, Dr. Johnson says.

"Spine is not always financially viable unless you are doing pain procedures," he says. "In terms of coverage with insurance, pain gets covered in every state, whereas every state is different for spine surgery."

4. Work with commercial payers to obtain coverage. Since the opening of his surgery center, Dr. Johnson has been in talks with Blue Cross Blue Shield to obtain coverage for the procedures performed in the center. Eight months after bringing XLIFs and ALIFs to the outpatient center, Dr. Johnson received word from the commercial payer that they would provide coverage.

"It's been an ongoing dialogue with Blue Cross Blue Shield for almost six years," he says. "To their credit, they've always been interested and willing to look at different things we've asserted the technology was there to do."

To prove to the payer that his procedures were safe and effective in the outpatient setting, Dr. Johnson gathered and presented compelling data. For instance, he performed 25 outpatient cervical fusions in a pilot study to show that no patients were readmitted, contracted infections or suffered complications.

"We reviewed the results with Blue Cross," he says. "Once they saw the outcomes were good, they approved all cervical fusions."

If physician owners are struggling to get all outpatient procedures covered for commercial reimbursement, they should work toward taking small "baby steps" with each procedure to prove its safety and efficacy, he says.

5. Try succeeding without outside partners. Dr. Johnson recommends physicians begin their single-specialty ASCs without the help of a joint venture or hospital partner, if possible.

ASCs are great investments for hospitals, he says, but physician owners often lose control and bargaining power in a partnership. It isn't profitable to the ASC in every situation to immediately begin with a partnership.

"Partnering right away can result in you giving up control and autonomy," he says.

However, once an ASC is more established and if the need arises for a clinical or financial partner, then the physician owner would likely receive a better return on his or her investment.

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