Digital Debut

Going it Alone

Reasons to remain independent in the age of joint ventures

BY ROBERT KURTZ | JANUARY 2019

Why would an ASC opt to stay independent instead of partnering with another health care organization? A partner might provide capital for facility expansions and new equipment or resources to assist with physician recruitment and managed care contract negotiations. Yet not all ASCs jump to take advantage of such potential opportunities.

Ambulatory Surgical Center of Stevens Point in Stevens Point, Wisconsin, is one such ASC. "We have been approached many times by organizations that want to affiliate or align with us," says Becky Ziegler-Otis, CASC, administrator of the ASC. "We face a lot of pressure to enter into a partnership but are trying fiercely to remain independent." The ASC has been independent since it opened in 2006.

G. Keith Smith, MD, anesthesiologist and founder of the Surgery Center of Oklahoma in Oklahoma City, opened his surgery center in 1997 and it also has always been independent. "We started an ASC because we found our ability to control how we practiced and the quality of the care our patients received was negatively affected when we did not have full control over all aspects of care delivery," he says. "We believe that if we now sold even a part of the ASC, we would be relinquishing some degree of control without bringing in anything we need."

Control is one of the principal reasons Ziegler-Otis says her ASC's physicians strive to maintain autonomy. "They value how much input they have into the day-to-day operations. They decide how they want to spend their money. They help select staff and surgical supplies. They choose which implant vendors we work with. This control makes them happy."

Independence translates into what Ziegler-Otis perceives as "less bureaucracy" concerning decision-making. "If we want to do something, we do not need to wait. A great example was our decision to start performing joint replacements in 2010.” One of the owners of the ASC wanted to give it a try and they were able to do so without jumping through hoops and holding countless meetings, she says. “I sat down with the surgeon and his nurse, we determined what we needed and then moved forward."

Philosophical and economic reasons further motivated Surgery Center of Oklahoma to become even more independent about a decade ago, Smith says. "We basically seceded from the entire health care system when we decided to stop filing insurance claims. We posted our prices online and let the market determine our success.” This was important to the center because it wanted to be a medical advocate for its patients but could not without being a financial advocate as well. “If patients have concerns about their costs, we work directly with them,” he says. “There is no interference from outside entities."

Smith says that his partners believe independence is so vital to the ASC's ongoing success that the partnership agreement is structured so the Surgery Center of Oklahoma can never be sold to another entity.

Ziegler-Otis acknowledges that remaining independent is not likely to get easier for her ASC. "There are entities excluding us from insurance contracts because we are not part of another organization. We are going to continue facing challenges to our financial viability and pressures to enter into a partnership." She is confident, however, that her ASC's plan to maintain autonomy will be successful. "Our vision is to keep growing and do so through creative means, such as bundling and attracting patients from outside our market. We also plan to keep performing more complex procedures. As long as we remain cost-conscious and continue providing high-quality care, we can survive."