Why independent ASCs' days are 'numbered,' per Dr. Jayesh Dayal

Practice Management

For some procedures, an office-based lab can be a beneficial option for ASCs, Jayesh Dayal, MD, said.

Dr. Dayal, owner of White Flint Surgery in Rockville, Md., joined "Becker's Spine and Orthopedic Podcast" to discuss the relocation of one of his ASCs and what physician leaders need to be successful.

Note: This is an excerpt. Listen to the full conversation here.

Question: What were the biggest driving forces behind the relocation?

Dr. Jayesh Dayal: Our lease was coming up for renewal, and we needed to expand. So what we're doing with the new place is we still will have two operating rooms that are designated operating rooms, but we will have more procedure rooms. What we've also added is what's called an office-based lab, which is the most exciting bit these days. And that's something that I would recommend every ASC look into. 

Q: Would you dive deeper on the OBL and kind of why you recommend this to other ASC owners?

JD: There's a huge misconception in the medical community about peripheral arterial disease. The technologies are getting very advanced but the literature hasn't kept up with [them] and the new results so people still quote old guidelines and old thought processes … It's a very untapped sort of a new business line that we've discovered, and the good news is that you really don't need an ASC per se to do these cases. It could be done in an OBL setting, and it does really well. Medicare pays adequately for these procedures, which is unusual … It's a very, you know, viable line of surgeries.

Q: Are there one or two tactics or strategies for ASC physician owners to really be successful in this day and age?

JD: Since they are allowing these much bigger surgeries, the days of the mom-and-pop surgery centers like mine are numbered. If you're doing a complex orthopedic case or a personal injury case or a workman's compensation case, the amount of coding complexity is really not feasible to do in-house anymore. 

Just because of the various rules that the CPTs keep changing as they migrate out of the hospital into the ASC setting. Just to keep up with all that, you have to outsource everything. What's turning out is that the days of independent ownership are kind of numbered, and most people are finding that they have to partner with either a hospital health system or a private equity group, so that's the unfortunate part. 

I really enjoyed the independence of having to call my own shots [and] running my own ASC the way I liked it. But unfortunately, that's not viable anymore because I have no leverage with the insurers. So unless you get hooked up with a PE or a national chain it's kind of impossible to maintain an independent facility anymore.

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