When you have the concept of [building the ASC], before you even put that first shovel in the dirt, you need to have already assessed what the payor environment is that you’re in. You need to have somebody already starting the conversation, calling [payors] on a regular basis. If you know they’re closed and not doing any new contracts, you can’t just hope for the best. That would be disastrous. Your actual negotiations can take up to several months and while your contacts may not go into effect until after you have received your state license and Medicare certification, you have to have all of your paperwork done prior to that.
You really have to analyze your book of business so you get carve outs for areas that you need carve outs for; you need to address implants as well. What we’re seeing is a lot more joint-venture ASCs and we’re really able to leverage contract negotiations by having a hospital partner. For situations where you don’t have a hospital partner, you take into consideration what your volume is [or is projected to be], are those providers part of the network for the professional side and you really try to get your physicians to use their current contracts as leverage to get ASC contracts.
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