These two specializations of spine surgery and pain management can be very complementary. The physical medicine or pain management specialist has the goal of non-surgical relief of back pain or neck pain, other musculoskeletal pain symptom. The surgeon shares that goal, wanting to exhaust non-surgical treatment options before surgery is considered.

If surgery is necessary, many spine surgeries — especially cervical surgeries —  can be optimally performed in an ASC environment where the patient goes home the same day.

After care can involve the primary care provider, or physical medicine physician who directs recovery and post surgical therapy for a successful return to activity.

Consequently, the Viking Surgical model weaves these specialties together for the benefit of the patient as well as the spine surgeon, pain specialist and referral sources.

There are plenty of large ASC development companies operating in Texas and Florida. The issue is that most involve a large number of partners who may have conflicting goals and motivations.

Many times the partners who get involved in these ASC projects split off over time as they realize large ASC companies often tend to develop mini-hospitals with all the inherent problems, internal competition for operating room block time and bureaucracy  — all the things that efficient surgeons are trying to escape from.  Many of these large ASC companies are interested more in the economic return to investors rather than meeting the needs of the surgeon or proceduralist.

So while the initial goal was to escape the large bloated administration of a hospital, if an ASC is too large, it simply replicates the problems of operating and doing procedures in a hospital.

Viking Surgical also now has ASC development projects underway in Florida, specifically in the rapidly growing Destin, Pensacola and Panama Beach region.

This particular Florida Gulf Coast area is an affluent market with a rapidly growing population. The area is know to developers and vacationers as “30A” which designates the busy main highway along the coast. 

Viking Surgical has developed several specialized ambulatory surgery center across Texas, including several around the Houston area. Many of these are specialized as designated spine surgery and pain management ASCs.

We have several embryonic projects where we have confidentiality agreements in place. Once the structure is established, we can then provide more information to other physicians who are considering Viking Surgical Management as their ASC partner.

Ambulatory Surgical Centers are sometimes called same-day surgery centers.

The Texas Ambulatory Surgical Center Licensing Act was enacted in 1985.

An ASC is required to provide surgical services as its primary service. An ASC typically does not provide overnight or inpatient care. Care is usually only provided on an outpatient basis. The Texas Health and Human Services Commission has rules that establish minimum standards for ASC licensing procedures, fees, and operating requirements for design, construction, fire prevention and safety.

Viking Surgical Managment has a proprietary ASC model that aligns the involvement of all the necessary physicians in a locale, including the spine and pain specialists, and those concerned with the spine care delivered to their patients. This includes primary care, family practice, internal medicine physicians along with chiropractors. All these providers have a vested interest in creating an ASC that enables patients to have surgery or procedure and be home the same day. This also keeps the patient out of the hospital which has more red tape and exposure to things like Covid.

An ASC operates exclusively for providing surgical services to patients with the expected duration of services not to exceed 24 hours following an admission.

The regulatory definition of an ASC does not allow the ASC and another entity, such as an adjacent physician’s office, to combine functions and operations in a common space during concurrent or overlapping hours of operations.

CMS does permit two different Medicare-participating ASCs to use the same physical space, so long as they are temporally separated with separate operations and records.

ASCs are not permitted to share space, even when temporally separated, with a hospital or outpatient surgery department.

Certain radiology services that are reasonable, necessary and integral to covered surgical procedures may be provided by an ASC.

The first step in the development of an ambulatory surgery center is understanding if it is financially feasible. Viking Surgical Management provides an assessment to determine the following:

  • What are the number and type of cases you expect to perform in your ASC?
  • If you have a practice computer system you can request a report for the last twelve months by CPT Code.
  • What is the annual volume of all surgical procedures to be performed in the ASC and the total value of the procedures?
  • What is the estimated ASC revenue compared to the cost of developing and building the ASC?
  • How much are your architectural fees, engineering and consulting fees?
  • How many operating rooms will you need and the cost of equipment and furnishings for those rooms to meet your needs?

Ambulatory surgery centers offer desirable value propositions as healthcare shifts toward lower-cost, higher-margin outpatient settings. ASC joint ventures can provide abundant opportunities for market growth with more diversified ownership risk.

There continues to be tremendous interest in outpatient ASC surgical centers. Provider groups looking to expand have seen value in affiliating with freestanding ASCs. ASC investors include physician providers looking to expand market share and to position themselves higher in their marketspace.

Future regulatory changes and reduced government reimbursement threatens independent ASCs to remain competitive with more dominant ASC peers and local hospital outpatient surgical departments. Joint ASC ventures and strategic partnerships offer sufficient alternatives because they permit more nuance in contract terms of the affiliation.

Many ASCs are strategically positioning themselves for future success by affiliating with more powerful allies for stronger positions in payer negotiations. Hospitals continue to expand their ambulatory setting with the industry moving toward value-based care. Hospitals need to offer lower cost alternatives both for private payers and government-based payers.

Hospital health systems and also are looking to diversify their revenue streams and leverage payment rates. Large ASC providers prefer joint ventures with larger provider networks and health insurers. Hospital are increasingly preferring joint ventured ASCs than acquiring sole ownership. The move to site-neutral payments has decreased the worth of sole ownership in off-campus ASCs. Freestanding ASCs typically receive 25-50% of what hospital outpatient departments receive for identical services and procedures. Hospitals are less inclined to acquire 100% ownership in an ASC today. Joint ventured ownership still allows the hospital to receive continuous benefits from outpatient procedures.

Some hospitals are starting to divest full ownership of their surgery centers for partial ownership with strategic partners. Joint ventured ASCs can help retain the hospital system’s best doctors. Joint ASC contract draws for surgeons include the potential economic upside of an ownership interest within the ASC, enhanced productivity within the ASC environment and also the patient experience within the ASC. Hospital-physician-ASC alignment strategies that foster cooperation offer significant opportunities for efficiency and quality improvements. Joint ventured ASCs in several geographic locations expand a hospital’s presence and patient base within the community, which might maximize patient access and capture increased market share by aligning with an ASC.

Many hospitals like the ASC administrative support. Hospital leaders aren’t as acquainted with overseeing ASC operations in an outpatient space. ASC companies can provide additional capital, operational expertise and knowledge mediating previous joint ventures. Hospitals are targeting larger multi-specialty ASCs when searching for a partnership.

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If you’re interested to see how Viking Surgical Management can help accelerate your ASC business, improve patient outcomes, and maximize efficiencies, please contact us below.