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COVER STORY


present a path for an ASC to partici- pate in an ACO or other population health model.” A joint venture can strengthen physician relationships with hospitals, which can prove helpful since many physicians who own and practice in ASCs perform their more complex cases at hospi- tals, he adds. The survey commissioned by


Avanza and Clark Hill indicates that nearly half of hospitals plan to invest in more ASCs. Dentler says physi- cians might be able to leverage the heightened interest in joint ventures. “In some of the physician employ- ment models we are seeing, negotia- tions include physicians requesting a new ASC. For example, if a hospital approaches an orthopedic group that owns a small ASC about a partner- ship, the group may stipulate that the building of a larger ASC is a require- ment of the deal.”


More partnerships are weighing the benefits of adding another part- ner, whether it be a large employer, payer or clinic in the area, Cooper says. “These partnerships need to explore these kinds of opportunities to leverage the economy of scale and compete with mega health systems.” As hospitals have added ASCs to their portfolio, they have started to emulate the management model used by ASC management compa- nies, essentially working to stan- dardize ASC processes without tak- ing control of operations, Dentler says. “That could mean all ASCs in their portfolio contract with the same technology service provider or accreditation organization, for example. More progressive hos- pitals are interested in supporting their ASCs and allowing them to maximize their efficiencies while leveraging the advantages hospitals bring to the table. That can be a bal- ancing act.”


Partnering with a hospital can make managed care contracting much easier. It also can present a path for an ASC to participate in an ACO or other population health model.”


—Roger Strode, Foley & Lardner


Independent ASCs have a clean slate and might be in a better posi- tion than those that are already part of a joint venture, Cooper says. “I view them like my teenage son: They have had a burst of growth and times of trouble but have so much poten- tial because they have no baggage. Many seasoned joint ventures seem to be experiencing struggles.” She describes these joint ventures as “more like bitter, married couples. What connected them in the past may no longer exist, but they con- tinue along and try to ignore reality because breaking up feels daunting.” Whether already in a joint venture


with a hospital or considering such a partnership, Cooper advises ASCs to evaluate their situation carefully


as part of their strategic planning efforts. Topics to examine include shared values, the value brought by each partner, compatibility of busi- ness approaches, views on what will make a partnership successful and levels of trust. “As years pass, external factors can greatly influence the reasons physicians and hospitals created an ASC partnership in the first place,” Cooper says. “In the coming years, as we get closer to a presidential elec- tion, we do not know how the cards will fall from a regulatory perspec- tive. These core matters are going to be instrumental for partnerships to weather a storm or shift accordingly to keep flourishing.”


ASC FOCUS JANUARY 2019 | ascfocus.org 21


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