Surgery group opening own ACS

[neuroride]

Will try to keep concise but the main surgical group( 5 ortho, 1 plastic surgeron, 1 general surgeon)
at my hospital and associated surgery center across the street are in the process of building their own surgery center with 4 ORs and attached extended stay area that is actually part of a new hotel. My anes group (4 docs and 17 CRNAs) currently covers the hospital and hospital partnered ACS. They are talking of taking most of all their cases to the new ACS 3 miles away, other than the large hospital cases(big belly etc).

The surgeon group wants us to provide anes for them but it will stretch our supervision duties and running the numbers to have staff over there for us will require quite a stipend as most of their cases are of the lowing paying cases. If we say no, then we will lose a lot of our volume and possibly have to let go a few CRNAs.

The hospital is not happy with the surgeon group obviously and is beginning to try to turn the screws on them even though they are behind the ball with the building already going up.

So the question is, at what point to you say that you need to follow the group over to keep your volumes but then possibly risk relations with the hospital who provides all of your business in some form right now? I would like our volume of business now to stay the same but we risk losing money doing crappy paying cases over there.

There is a part of me that thinks that being more diversified with different locations would be more advantageous would be best for the long term but that assumes that this surgery center actually succeeds.

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[nimbus]

Will try to keep concise but the main surgical group( 5 ortho, 1 plastic surgeron, 1 general surgeon)
at my hospital and associated surgery center across the street are in the process of building their own surgery center with 4 ORs and attached extended stay area that is actually part of a new hotel. My anes group (4 docs and 17 CRNAs) currently covers the hospital and hospital partnered ACS. They are talking of taking most of all their cases to the new ACS 3 miles away, other than the large hospital cases(big belly etc).

The surgeon group wants us to provide anes for them but it will stretch our supervision duties and running the numbers to have staff over there for us will require quite a stipend as most of their cases are of the lowing paying cases. If we say no, then we will lose a lot of our volume and possibly have to let go a few CRNAs.

The hospital is not happy with the surgeon group obviously and is beginning to try to turn the screws on them even though they are behind the ball with the building already going up.

So the question is, at what point to you say that you need to follow the group over to keep your volumes but then possibly risk relations with the hospital who provides all of your business in some form right now? I would like our volume of business now to stay the same but we risk losing money doing crappy paying cases over there.

There is a part of me that thinks that being more diversified with different locations would be more advantageous would be best for the long term but that assumes that this surgery center actually succeeds.

Are you sure they plan to take the crappy cases to their own surgicenter? Usually they save the crappy cases for the hospital and pick off the cream for their own surgicenter.

 

[Southpaw]

Are you sure they plan to take the crappy cases to their own surgicenter? Usually they save the crappy cases for the hospital and pick off the cream for their own surgicenter.

Yeah, this. Follow them over if you want to watch out for your own business interests.

 

[dhb]

4 MDs to 17 CRNAS ...

 

[jwk]

4 MDs to 17 CRNAS ...

Yeah, I thought the same thing.

How many rooms do you staff at the hospital now?

 

[Man o War]

Why do you believe the cases they will do over there are low paying? I’ve never seen a no pay done at a surgicenter, and our orthos hardly ever took government pay cases to their surgicenter.

 

[norwood]

Why do you believe the cases they will do over there are low paying? I’ve never seen a no pay done at a surgicenter, and our orthos hardly ever took government pay cases to their surgicenter.

Depends on the workflow at the hosp owned center, though. If the hosp guys are slow (teaching facility?), the orthopedic surgeons may be less selective in what they bring to the ASC.

 

[neuroride]

We run 5 ORs at the hospital and 4 OR/1 GI suite at the other surgery center. At their current volume at the surgery center now, we would need even more volume at the brand new ACS just to break even paying for the CRNAs assuming that they pull almost all of their cases over to the new place.

 

[BobBarker]

The anesthesia charges are going to be big. All of their auto, wc, cosmetics, good privates. You need to buy in to the ASC.

 

[pjl]

You need to evaluate the finances, and we can't help with that. Being a cofounder may be beneficial, but at least there is a high likelihood that the practice will be lucrative even if you don't own it. Not all surgery centers are mints, but they certainly can be.

I have a hard time believing you will need a subsidy for a surgery center, or that you would get one. I think that line of thinking should be thrown out, which is what I would do if you asked me for a subsidy to staff my surgery center.

 

[BobBarker]

One of your group is going to jump ship and get the exclusive contract for the ASC and buy in and steal your best CRNAs.

This ASC needs to have a pain physician. SCS pays great in the ASC. The other stuff pays fine for the amount of resources used.

https://asipp.org/documents/2018ASCFinal.pdf

Add up 63685 and 63650 X 2 for the price of the implant. 63650 x 2 is a trial.

Total system cost can be under $20k.

 

[neuroride]

We would move our pain procedures over there as well. There is a lot going into the decision but the hospital getting pissed and canning us for going where the work is is another real fear.

I am invested in the "hospital" back surgery center already so I would need to dump my shares there to buy into the new surgery center bc of noncompete rules.

 

[BobBarker]

That makes things very complicated. Hard to say what is the best decision now.

 

[Aether2000]

Most new surgery centers are intentionally out of network for the first year or two. The surgeons financially rape the community for the first year or two by charging confiscatory rates, and not offering the patient any choice about having the procedures in a facility covered by their health insurance. A surgery center in Columbus Indiana charged patients $57,000 for a 15 minute endoscopic sinus surgery and $200,000 for a hip replacement. Insurance covers zero, and the surgeons bank on patients paying off these astronomical sums over a period of years. Most new surgery centers do not provide treatment for Medicaid, Medicare, or uninsured self pay patients.

 

[Noyac]

As BobBarker said above, either your group finds a way to cover the SC or someone in your group will take it and jump ship.

 

[caligas]

Do you have a business adviser?

Tough decisions for a bunch of dumb doctors

 

[dchz]

so it's impossible for us to completely weigh in without knowing all the details.

here is how i would reason through this:

Survey the local market, are you guys a big group in a little pound, or are there anes begging on the streets for work?

You have to realize it costs the hospital a very substantial amount of resources to get another anes group in there. Theoretically there are a subset of moves that are win win situations, whether you strike the optimal one depends on how well u survey the local market.

 

[Wiscoblue]

You have to get the surgicenter contract even at the cost of losing this Hospital contract. All the patients with insurance will go to the ASC. The Medicare, Medicaid and sick fat patients will be at the hospital. Huge difference in average unit value.


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[DoctwoB]

Most new surgery centers are intentionally out of network for the first year or two. The surgeons financially rape the community for the first year or two by charging confiscatory rates, and not offering the patient any choice about having the procedures in a facility covered by their health insurance. A surgery center in Columbus Indiana charged patients $57,000 for a 15 minute endoscopic sinus surgery and $200,000 for a hip replacement. Insurance covers zero, and the surgeons bank on patients paying off these astronomical sums over a period of years. Most new surgery centers do not provide treatment for Medicaid, Medicare, or uninsured self pay patients.

That is remarkably unethical. I wonder if any laws are violated by deliberately steering patients to an out of network facility without appropriately informing them.

 

[deleted162650]

Is there some kind of non-compete in your contract with the hospital that prevents your group from covering other facilities? If not, and the hospital canned you guys for covering the new center, I think you'd have a pretty good case against them.

 

[neuroride]

Thanks for the replies, this is still ongoing and getting more complicated by the day. The hospital/surgery center that exists now has sued the surgical group building the new surgery center for violating non-compete for starting construction. The hospital just won a prelim hearing for an injunction against them.

To make things MORE confusing....The hospital is now having financial shortfalls too, just like everywhere else. We receive a monthly stipend mainly to cover an in house CRNA for call at nights and weekends. They have brought in a consultant to review our numbers and decide on whether the stipend is fair value or not. They are just mainly seeing if they can cut out our stipend to zero to save money. If they cut our stipend my feeling is that this is the last straw and we need to pick up this new surgery center to make up that lost income.

I need an EGD to check on my ulcer........

 

[chocomorsel]

I have never understood why when docs are on call why they need a CRNA.
Unless more than one case is going on, it seems like a waste of money. Are you leaving the CRNA in the ORs while you go from room to room in OB popping epidurals?

 

[Man o War]

I have never understood why when docs are on call why they need a CRNA.
Unless more than one case is going on, it seems like a waste of money. Are you leaving the CRNA in the ORs while you go from room to room in OB popping epidurals?

In my old group, yes that's why we did. We had a very busy OB service there and frequently ran rooms at night, mostly for vascular BS. It was too lean with just the doc in house.

 

[chocomorsel]

In my old group, yes that's why we did. We had a very busy OB service there and frequently ran rooms at night, mostly for vascular BS. It was too lean with just the doc in house.

This would be the only time it made sense I can think of.

 

[neuroride]

Yes, we are the man for everything....I do all the epidurals, lines occasional and then supervise ORs. If the nurse is a case in the OR, I cover intubations, epidurals or STAT sections