Payer pressure, evolving regulations, and consumer demand for more convenient and cost-effective care have accelerated the migration of surgical cases from traditional hospital sites of service to ambulatory settings. While some health systems have already developed an effective ambulatory surgery center (ASC) strategy, others are realizing that without one, they risk losing those cases permanently. Nowhere is this more evident than in women’s health, as services such as gynecology, breast surgery, and reconstructive surgery transition from hospitals to outpatient settings.
Similar to how women’s health adapted to the migration of imaging services decades ago, leading women’s health programs, whether part of a dedicated women’s hospital or within a larger health system, need an ASC strategy to achieve long-term sustainability. Below are four key steps any women’s program needs to undertake when designing one.
1. Understand Your Program’s Vision
Determine the types of services that should be provided and the patients they will cater to. These decisions will be unique to each organization based on its specific needs and vision for the delivery of care. A couple of scenarios are common:
- In the first scenario, a smaller, dedicated women’s health campus without an ASC may identify close to 2,000 women’s procedures (e.g., hysteroscopies, fibroid surgery, breast biopsies or reconstruction) that are at risk for migrating out of the system completely and decide that developing a small, one- or two-room licensed ASC on campus will be necessary to keep those cases within the system.
- In the second scenario, a large health system that has embraced women’s health as a cornerstone of its overall strategy may choose to develop a large, multispecialty ASC capable of providing affordable, comprehensive surgical care to all members of a woman’s family, with women’s health services being a key service among a broader offering.
2. Engage the Right Physicians
Critical to the success of any ASC is an engaged group of surgeons who are intimately involved with the facility’s planning, day-to-day operations, and management—and in many cases, are investors in the center. Early in the planning process, engage potential surgeons to gauge their interest in being a part of the ASC.
Essential to any women’s program is the ability to provide convenient, customizable care. Identify physicians whose perspectives on care delivery align with this vision. Furthermore, knowing which surgeons will be involved will drive other key aspects of ASC planning, including forecasting case volumes, understanding room capacity requirements, and developing a pro forma, which will ultimately determine the feasibility of the enterprise.
Often, a joint venture between the hospital and physicians is the optimal method for creating alignment between the parties, as it means the physicians will have “skin in the game.” A common historical equity model was often a 51%/49% split between the hospital and the physicians; however, partnerships with higher hospital equity—say 70%—are becoming increasingly more common, as hospitals can optimize resources to better fulfill capital requirements (like robotics) and may be able to negotiate stronger contracts with payers.
3. Decide Whether to Start from Scratch or Invest
Once you’ve determined your specific ambulatory surgery needs and identified potential surgeons for involvement, decide whether to create a de novo ASC or buy into an existing one. Each option has benefits and drawbacks.
- For example, buying into an existing, well-managed ASC often mitigates the steep learning curve associated with building and running a brand new center; however, it may mean compromising on other aspects of the partnership (e.g., decreased equity and/or control).
- Conversely, developing a de novo ASC could allow for the creation of a surgery center that is highly customized to serve the unique needs of the program’s patients. But opening a de novo facility can be a painful experience without the assistance of a third party with ASC expertise.
Other questions to consider:
- What is the desired location of the ASC, and how will this impact physician scheduling, the patient experience, and your strategic facility master plan? For example, does your organization have an existing or planned outpatient women’s center that could host the ASC?
- What services will be offered at the ASC, and what other services or facilities might they pair well with?
- How many ORs are needed, and what is the minimum viable number?
- How will the ASC fit into your broader women’s health strategy?
4. Don’t Run an ASC Like a Hospital
Either during the planning and design process or once the center opens, organizations that are dipping their toe into the ASC space often make the same mistake of developing and running the facility like a hospital. Remember why physicians and patients prefer having procedures performed at ASCs: care tailored to each patient, fewer delays, lower costs, higher nurse-to-patient ratio, lower risk of infection, etc. Unfortunately, hospitals often can’t help themselves; when they see the shiny new toy next door—a beautiful ASC—despite intending to provide support, they frequently introduce unnecessary bureaucratic and administrative burdens. Avoid this temptation, and enable the ASC to run as efficiently as possible.
Taking the Plunge
While women’s health programs across the country recognize that an ASC is a crucial component to providing comprehensive and convenient care to their patients, the ASC space is often unfamiliar territory. It can also be challenging to understand how an ASC plan fits into a broader women’s health strategy. Don’t go it alone; hire someone with ASC experience or contract with a third party with relevant expertise to ensure your enterprise is successful and the women’s health service line achieves its objective.
Edited by: Matt Maslin
Published August 24, 2022