Joshua Siegel, MD, founding member of Access Sports Medicine & Orthopaedics in New Hampshire, opened the Access Sports Medicine ASC last year, the second ASC he developed with other physician-owners.

Here, Dr. Siegel shares his insights on the benefits and challenges of developing an ASC as a physician:

Note: Responses have been lightly edited for style and clarity.

Question: What was the process like, developing the Access Sports Medicine ASC as a physician? What advice would you give to other physicians looking to develop an ASC?
Dr. Joshua Siegel: 

Developing and building a new ASC is a lot of work, but with the right architect and builder, it can absolutely be done without engaging an ASC development company. We spent some time researching sites and purchasing land and then set up consistent weekly meetings to move the project forward. Staff would meet once a week, and meeting with the architects and builders would occur bimonthly.

Healthcare architects are important because they understand the flow through a healthcare facility, although one has to be careful. Healthcare architects that have mainly worked with hospitals tend to overbuild, not recognizing the importance of efficient design and costs that make lower reimbursed non-hospital-based projects viable. On the other hand, I have noticed that ASC companies like to only consider healthcare facility builders. I feel that shuts out many talented local builders who help support the local economy.

My recommendation is to hold multiple meetings, use a healthcare architect and a local builder, and have a reliable staff you can depend on to complete tasks. Start with a small group of physician-owners so you can get the ASC off the ground, and then offer equity later to others after the center is up and running.

Q: What are the benefits of developing an ASC with a surgeon-owner? What are the challenges? Looking back, is there anything you’d do differently?

JS: This is the second time I’ve built an ASC. I built one in 2000, and I opened another one last year. The benefits of having surgeon-owners are the shared vision and the common purpose. The ASC is a place where we will spend a good part of our professional lives, and we want to be able to have a facility that is comfortable, warm and inviting. We want efficiency, great staff and a good flow. Non-physician owners may say they want the same, but either do not understand what that is or cannot provide it. The surgeons have to have control to get what they want. That way, everyone who is producing value is also benefiting from the building of the ASC. I think when you start getting other companies involved, whether they’re ASC companies or equity partners, there is not the type of alignment that leads to all physicians being satisfied with the end product.

Healthcare is also very local or regional. Local surgeons recognize the need for certain equipment, alliances, relationships and services in their local markets whereas outside investment may not.  

The challenge of developing an ASC as a surgeon-owner is the time spent away from clinical duties to get it done. Negotiating the purchase of the land, the building, the leases, the equipment, the hiring, the oversight — all take time and can be hard, if not impossible, to delegate. But, if you recategorize this as learning rather than a chore, it can be fun and exciting. Our group was fortunate in that we avoided the arguments common among doctors who build ASCs mostly because of the shared vision I mentioned earlier.

One mistake is that we went with a nonlocal vendor for non-ortho equipment (beds, monitors, etc.) that performed poorly. I would consider contracting only with vendors who guarantee timelines and back their commitments with penalties and incentives. Our experience with this vendor was poor, and we had a delay in opening, which was costly.

One mitigating equipment aspect to our build is that we had a great partner in Smith & Nephew, who helped us with procuring orthopedics equipment and financing.

Q: Can you touch on advances in minimally invasive surgery/anesthesia? What trends in outpatient surgery are you most excited about?

JS: The largest contributors to the growth in outpatient surgeries are from anesthesia and surgical technology advancements. Regional blocks, indwelling catheters, better use of short-acting agents and opioid-free surgeries have been instrumental in allowing cases that used to require overnight stays to go home on the same day.

Technological advances, such as better visualization and instrumentation systems, have made the surgeries quicker, less invasive and more thorough, allowing us to do more in less time. That has downstream effects on recovery, infection rates and outcomes that allow us to expand the indications for surgeries.  

So not only is the market growing as the population grows and ages, but the actual procedures we can do in an outpatient setting  are also growing.

Lastly, growth is also occurring through new procedures that address problems that previously had no surgical options.

I am also very excited about the blossoming biologic field in orthopedics. We are seeing traditional orthopedic procedures either augmented, or even replaced, by biologic advancements in our field.

Q: Where do you expect to see the ASC industry going in 10 years?

JS: The ASC industry is going to continue to grow — maybe even logarithmically. Hospitals have gotten into the game, recognizing that the same or better care can be delivered more conveniently and more cost effectively by developing ASCs. With private equity also getting into the game, we will see the number of ASCs continue to increase to meet the market needs.  Consolidation has also emerged and is stimulating the building of more independent ASCs. Clearly, the entire healthcare industry recognizes the vital role of ASCs in the healthcare delivery system.

Written by Rachel Popa for Becker’s Spine Review on May 15, 2019