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FEATURE


the hospitals, but the long-term strategy reflects the way healthcare is moving, so we know we must embrace it. This will eventually be a win-win for all.” Physicians also need to keep the


long-term outlook in mind when their hospital partner asks for help, Ertel says. In 2011, an orthopedic surgeon who only performed total joints at The Reading Hospital was being courted by a specialty hospital. This surgeon told the hospital that if he were not permit- ted to become an owner in The Reading Hospital SurgiCenter at Spring Ridge, he would accept the specialty hospital’s offer. There was one issue: In Pennsyl- vania, total joints are not yet approved for ASCs. “The ASC’s physician members were hesitant to allow him to buy in since he could not perform his proce- dures at the center, but it would be a major problem for the hospital to lose one of its main orthopedic surgeons,” Ertel says. “After discussions, the phy- sicians understood that the benefits of helping their hospital partner by allow- ing this surgeon to buy in to the ASC would outweigh the lowering of their distributions. In addition, total joints will hopefully soon be permitted in Pennsylvania ASCs. When that day comes, the physicians will have that surgeon in their pocket.” A joint venture ASC flourishes when the hospital leverages its vast resources, St. Louis says. When one of BayCare’s ASCs started performing total knees, the center borrowed trays from a Bay- Care hospital. “This gave the center time to build up cash and buy its own trays,” she says. “Once a hospital gets physicians invested, you want to keep helping meet their needs. They are tak- ing on smaller ownership in the ASC because that ownership is shared with the hospital. This arrangement can still be lucrative for physicians because of the advantages of a hospital partner.” Northwell Health’s joint-venture team members are also invested in


because emergent cases happen and cases get bumped all the time. It is difficult to keep a hospital OR sched- ule running as smoothly as you need to in an ASC.”


Everyone must be willing to have conversations about difficult decisions. Our physician board members make every meeting and are accessible in between them.”


— Pamela Ertel, RN, CASC The Reading Hospital SurgiCenter


delivering support to their ASCs, says Susan Fitzpatrick, the organization’s assistant vice president of joint venture clinical operations. “We view each of our ASCs as being unique in their needs and goals. Some need a little support. Some need a lot of support. Some do not need much support at all. When support is provided, we work alongside our physician partners as opposed to telling them what to do.”


As important as it is for a hospital


to help its ASC, St. Louis says, know- ing when not to help is just as impor- tant. For example, a hospital’s acute care operating room (OR) director should not be put in a similar position in an ASC, she says. “The ORs are not run the same way. ASC ORs should be run efficiently and effectively, with the goal of getting physicians in and out as fast as safely possible. In a hospital, you cannot typically do that


Tackle Challenges Together A joint venture ASC partnership will inevitably be put to the test when chal- lenges arise. Ertel has helped her cen- ter work through many challenges over the years. When the ASC expe- rienced rapid volume growth in its early years, a few hospital leaders and OR staff began viewing the ASC as competition. More recently, the pan- demic strained the hospital’s finances, leading to cost-cutting measures that affected the ASC. Ertel says the ability for the ASC’s physicians and hospital to effectively collaborate has helped overcome these obstacles. “Everyone must be willing to have conversations about difficult decisions. Our physician board mem- bers make every meeting and are acces- sible in between them. The hospital’s board members have also acknowl- edged when we needed to engage in difficult conversations and carved out the time to talk through them.” At Northwell Health, Varghese says,


“We go into these projects with expec- tations that are clear and then try to ful- fill them. Things change along the way, so you must be flexible. Having part- ners who understand the importance of being nimble and adapting as needed has allowed us to have true partnerships that are never one-sided.” To make ASC joint ventures work over the short and long term, try not to lose sight of the partnership aspect, St. Louis says. “When you decide that physicians are going to be your part- ners, you pretty much decide they are going to be your partners for life. While it does not always work out, you hope most of these physicians will stick with you.”


ASC FOCUS JUNE/JULY 2021 | ascfocus.org 17


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