Establishing an Office-Based Lab (OBL) or a Cardiology/Cardiovascular (CV) surgery service line in an Ambulatory Surgery Center (ASC) can be a strategic move to expand service offerings and increase patient access to specialized care. Having spent time building OBLs at established ASCs for Saturday block times is something I've been doing successfully for the past few years.
However, the feasibility of such a venture requires careful consideration of various factors. Here’s my high-level checklist with a guide for doctors and investors to use some back-of-the-napkin ideations for adding these service lines to an existing ASC setting.
- Licensing Requirements: Ensure the ASC meets all state and federal licensing requirements for OBL or CV surgery services.?? Easy
- Accreditation: Verify the need for accreditation from bodies like The Joint Commission, AAAHC, or other relevant organizations. You are a separate entity so the existing Accreditation does not apply. You’ll need your own. Not cheap; Not easy. Takes time before you can even qualify for the inspection.
- State Laws and Regulations: Review state-specific regulations regarding ASCs and the types of procedures that can be performed. Easy.
- Reimbursement Policies: Understand Medicare and private insurance reimbursement policies for OBL and CV services in an ASC. Easy.
2. Financial Considerations
- Capital Investment: Assess the initial capital required for equipment, facility modifications, and staffing. Basic MBA stuff.
- Operating Costs: Estimate ongoing operating costs, including salaries, supplies, maintenance, and administrative expenses. Basic MBA stuff.
- Revenue Projections: Develop realistic revenue projections based on expected patient volume and reimbursement rates. Basic RCM stuff if you know which CPT codes you intend to offer. A MBA cannot do this without clinical background.
- Break-even Analysis: Calculate the break-even point to determine the timeline for profitability. Basic MBA stuff.
- Procedure Variability: Different surgeons may require varying times to complete the same procedure (skin-to-skin time) under the same CPT code. This variability can impact financial planning, particularly when setting prices for bundled case rates.? This takes knowledge of the surgical environment. It is not “just math.” Preference Cards and Implants: Surgeons often have different preference cards, implants, and hardware selections, which can significantly affect the cost of a procedure. Each surgeon’s approach and requirements must be analyzed to accurately determine the total cost per procedure.? A scrub tech, sterile supply processor and the person who does the ordering of supplies, implants and hardwares is necessary to team up with the project lead on this. Bundled Pricing Software: Utilizing specialized software, such as Bundlr from Maria Todd, can assist in this analysis. Bundlr analyzes detailed cost data by minute in the OR, by CPT, by surgeon, and by facility. It incorporates the ASC's cost data and preferred profit margins to generate a bundled package price for each CPT code. Data Integration and Analysis: The software can compare deidentified cost and pricing data across different surgeons on the medical staff, enabling the ASC to set competitive and profitable bundled rates and decide which surgeons to recruit for a bundled case rate program.
- Demand Assessment: Conduct a market analysis to gauge the demand for OBL or CV services in the region.? Market researcher with clinical knowledge.
- Competitive Landscape: Identify existing providers and evaluate the competitive environment. Market researcher with clinical knowledge
- Referral Network: Establish relationships with primary care providers and specialists for a steady referral stream. A business development person with boots on the ground.
- Space Allocation: Ensure adequate space for procedure rooms, recovery areas, and support services.? Older built ASCs may be too small to be comfortable or efficient.
- Equipment Needs: Identify and procure necessary equipment, including imaging systems, surgical instruments, and monitoring devices.
- Infrastructure: Ensure the facility infrastructure supports the technological and operational needs of the service line (e.g., power supply, HVAC).? Take into account accreditation requirements!
- Qualified Personnel: Recruit experienced and credentialed physicians, nurses, and technicians specializing in cardiology and CV surgery.
- Training Programs: Implement training programs for all staff to ensure high-quality patient care and adherence to protocols.
- Support Staff: Ensure sufficient administrative and support staff for scheduling, billing, and patient coordination.
6. Clinical Protocols and Quality Assurance
- Clinical Guidelines: Develop and implement clinical protocols for all procedures to ensure standardization and safety.
- Quality Control: Establish a quality assurance program to monitor outcomes, patient satisfaction, and compliance with regulations.
- Infection Control: Implement stringent infection control measures to maintain a sterile environment.
7. Patient Care and Experience
- Patient Flow: Design efficient patient flow processes from admission to discharge to minimize wait times and enhance patient experience.
- Post-Operative Care: Develop comprehensive post-operative care plans, including follow-up visits and patient education.
- Patient Education: Provide thorough education to patients about procedures, risks, and recovery processes.
8. Technology and Information Systems
- Electronic Health Records (EHR): Integrate an EHR system to streamline patient documentation and information sharing.
- Telemedicine: Consider incorporating telemedicine services for pre-operative consultations and post-operative follow-ups. That way, you can attract medical travel patients who are redirected to you for surgery away from their hometown network.
- Data Security: Ensure robust data security measures to protect patient information.
- Liability Insurance: Secure appropriate liability insurance coverage for the new service line.
- Emergency Protocols: Develop and rehearse emergency response protocols for potential complications or adverse events.
- Compliance Audits: Conduct regular compliance audits to identify and address any areas of concern.
10. Community Outreach and Marketing
- Community Engagement: Engage with the community through health fairs, seminars, and educational events to raise awareness of the new services. The business development for this is NOT free social media posts.
- Marketing Strategy: Develop a comprehensive marketing strategy, including online presence, social media, and traditional advertising, to attract patients… ONLY IF YOUR TARGETED PATIENTS CONSUMES HEALTHCARE INFORMATION THIS WAY!
- Patient Testimonials: Collect and showcase patient testimonials to build trust and credibility.
By carefully considering these factors, doctors and investors can determine the feasibility of establishing an OBL or cardiology/CV surgery service line in an ASC. This checklist serves as a comprehensive guide to ensure all critical aspects are evaluated, laying the foundation for a successful and sustainable expansion of services.
