Work your vendors & don't inflate revenue projections: 2 ASC leaders on adding new procedures

Practice Management

When adding new procedures at your ASC, it's vital to paint a full picture of their costs and weigh them against projected revenue.

During Becker's ASC Virtual Event on Oct. 16, Brian Gantwerker, MD, spine surgeon and CEO of Craniospinal Center of Los Angeles, and Tracy Hoeft-Hoffman, administrator at Heartland Surgery Center in Kearney, Neb., discussed key considerations for incorporating complex spine and orthopedic procedures into the ASC setting.

Below is an excerpt from the conversation, slightly edited for clarity. To view the full session on-demand, click here

Question: What does it take to add new complex procedures to your ASC? How will you know when it will be worth it?

Dr. Brian Gantwerker: You have to establish what your expected reimbursement per case will be as well as the upfront capital and maintenance costs. Determine very honestly what that breakeven point is going to be. Unless you're lucky enough to have a line around the block for this new procedure or new thing you want to do, it's very hard to predict. You could easily build the field of dreams and no one comes. I think you really have to interact with your billing and administrative staff and don't inflate numbers, because it doesn't help anybody to be dishonest about that stuff. If you're offering something novel, have a demand and a way of getting the word out, I think you will do well. 

Tracy Hoeft-Hoffman: First off, work your vendors to get a deal. I worked with them for a solid six months before we got a [total joint replacement] robot in place. It did come with some additional expenses because of instrument trays, but we projected how many cases our two total joint surgeons would be able to do. We projected numbers and we tiered our program with the robot based on incremental volume over seven years to make it affordable for us. You have to do that because you can't just pay that money up front when you're an ASC in the middle of a pandemic. 

During the pandemic, we took advantage of becoming a hospital without walls. So, with Medicare patients, we are getting a hospital outpatient department rate, rather than an ASC rate from Medicare. We did that to take the surgical burden off the two hospitals in our community. You have to make sure you have everybody on board and don't inflate numbers. I tend to undervalue the numbers a little bit, so it sets a best-case scenario.

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