cial payer base, the OBS is not finan- cially viable for treating these patients,” he says. “The ASC is a better option because it is more financially viable and is rigorously regulated by the state and federal governments.”

Challenges All images in the article taken at Avicenna Ambulatory Surgery Center in Bronx, New York.

Lessons Learned Operating ASCs in Low-Income Areas

Be cognizant of financial obstacles and cultural differences BY SAHELY MUKERJI


unning an ASC in a low-income area is fraught with risks, delays

in payment, demands from the Depart- ment of Health and the fire department, and other adverse factors, says Roy Bejarano, president of Frontier Health- care in New York, New York. “It is a fragile and delicate situation,” he says. “ASCs, however, are the smarter health care option for low-income areas be- cause they offer high-quality care at a lower cost than hospitals and are more specialized than hospitals.”

ASCs also are a better option than

private practices because physicians are expected to practice in a specific manner in an ASC, he says. “They have to do risk assessment, report quality, use electronic reporting and have a lot of oversight on top. ASCs, typically, are pretty small and pretty compliant and have consistency in quality.”


Jay Weissbluth, MD, co-medical director of South Brooklyn Endoscopy in Brooklyn, New York, agrees that hos- pitals and office-based settings (OBS) are not the best match for low-income areas. “The hospital model costs 30–40 percent more than the ASC model, and unless you have a large commer-

Only 25 percent of our patients in the Bronx use texts. We did a survey and found that 85 percent of our patients prefer a phone call and a live person instead of getting texts. It is their culture.”

— Sean Daneshvar Avicenna Ambulatory Surgery Center

The most critical challenge in run- ning an ASC in a low-income area is poor reimbursement rates, says Sean Daneshvar, president and founder of Avicenna Ambulatory Surgery Cen- ter in Bronx, New York. The patients in low-income areas are mostly Med- icaid patients. Daneshvar, an Iranian immigrant, has had a medical center in the Bronx for 26 years and opened his ASC in 2015 in the center’s lower level. “The hospital had been the only option for the people in this area before I opened my medical center,” he says. “I don’t have any cash patients, they are all Medicaid and Medicare. We are doing orthopedic procedures, GI procedures, vascular procedures, podiatry and are about to embark on spine surgery.” There is a long line of patients

waiting for surgery in the Bronx area because they have Health Maintenance Organization

(HMO) insurance or

Medicaid only, and their reimbursement rates are very poor, Daneshvar says. “For example, a hysteroscopy pro- cedure costs $3,000 in my ASC but the HMOs pay us $1,800 for it. So we lose money on each procedure,” he says. Orthopedic procedures also are reimbursed poorly but GI, urology and ophthalmology procedures have better reimbursement rates, he says. “If the insurers increased the rates, this facil- ity would be flooded with patients. I have a long list of orthopedic cases that I must send to the hospital and God knows when they will be done, but I can’t afford to perform them in my ASC,” he says. Avicenna is trying to bring in commercial cases but, for now, those

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