While there's no single path to success, many high-volume eye centers have similar traits. Here are 9 secrets behind some of the busiest eye surgery centers in the nation.

1 Bring in more surgeons
Since many eye surgery centers are closely linked to ophthalmic practices whose partners bring their cases to the surgery center — often in the same building — adding in more partners brings quick growth. Merging with a like-size practice can double your volume nearly overnight.

"I'm a believer in group efforts," says Marnix Heersink, MD, FACS, FRCPC, an ophthalmologist who founded Surgery Center South in Dothan, Ala., in 1985. Merging with another practice increased volume without adding overhead to the surgery center. Now with 6 ORs, the center does more than 12,000 cases per year. "The biggest challenge was the personalities," says Dr. Heersink.

2 Treat surgeons like customers
Regardless of whether your eye surgeons are owners, make sure they have the best possible experience in your facility. If surgeons from a practice that competes with the owners' practice use your facility, bend over backwards to make them feel welcome and accommodated. "I went to my direct competitors and gave them first crack at the block time," says Frank Cotter, MD, medical director of the Roanoke Valley Center for Sight in Salem, Va. Make sure that non-owner surgeons are represented and have a say at quarterly board meetings. This will go a long way in reducing mistrust and jealousy, he says.

Engage your surgeons to see what they like and what they don't like about your center, staff and the way you do things. "I continually ask them if there are any improvements we can make," says Dr. Cotter. "When they do make a recommendation, we do it." For example, if a surgeon requests a specific chopper or phaco tip, Dr. Cotter makes sure the center gets it. The instrument may cost $300 or $400, but it's worth it when you consider that the surgeon may be bringing 80 cases a month. "Over the course of 10 years, it's not a very big investment," says Dr. Cotter.

3 Let fast surgeons go fast
Most eye surgeons work pretty quickly, but some go extremely fast. So let them. Open up 2 or even 3 rooms for your fastest cataract surgeons, says Kathy Stout, RN, administrator of the Eye Surgery Center of the Carolinas in Southern Pines, N.C. "We have some pretty quick surgeons," says Ms. Stout. "It helps to have that third room." How do you know a surgeon can handle 3 rooms? If the surgeon is doing cataracts in 4 or 5 minutes, then they can handle 3 rooms, if you have them all available, says Ms. Stout.

Proper staffing and standardization are the keys to seamless use of 2 or 3 rooms, says Ms. Stout. The surgeon and surgical team should be able to do everything in exactly the same manner in each room. Staff each room with a nurse, circulator, surgical tech and an anesthesia provider. Set up the microscope, OR bed or chair, carts and tables in the same place in each room. Storage cabinets should be located in the same place in each room and the supply shelves should be stocked in the same manner. The end result should be that everyone works in the exact same manner regardless of which room they happen to be in.

4 Add retina
Expanding the range of surgical services that you offer can bring more volume to your center. Retina is a good option, especially since Medicare reimbursement has actually been improving for these procedures over the last few years. The ASC reimbursement for a vitrectomy and a repair of a detached retina, the 2 most common retina procedures, is about $1,500 for each procedure. But there's a hefty start-up cost. Plan on $300,000 to $425,000 to purchase a pair of vitrectomy machines, a laser, a light source and "a boatload of new instruments," says Todd Albertz, director of surgical services at the Cincinnati Eye Institute in Ohio. The length of the procedures (45 minutes to 1 hour) is also a challenge to get used to if you've been doing mostly cataract surgery. "It's a different mindset for the staff," says Mr. Albertz.

5 Offer oculoplastics
As the baby boomers age, their eyelids continue to sag. Blepharoplasty is an added service that has brought many new cases to St. Luke's Surgical Center in Tarpon Springs, Fla. For this service they wanted an oculoplastic surgeon who was fast and had a track record of good outcomes. "We had to find the right surgeon," says Brad Houser, MBA, administrator. The addition has paid off. In 2010, St. Luke's surgeons did blepharoplasties on 1,150 eyelids. Blepharoplasty on both eyes are 2 separate procedures with the first facility fee reimbursed at 100% and the second reimbursed at 50%. For both, Medicare pays a total of about $1,200. Many times, particularly in older patients, upper lid blepharoplasty qualifies for private insurance coverage. The procedure has a $50 to $75 supply cost — suture, draping, prepping and cautery tips — and takes about 15 minutes for 2 eyes. "Staff is your biggest cost," says Mr. Houser.

Learn as much as you can about the surgeon from other physicians, nurses and managers at other facilities. Bring in the surgeon and spouse to meet the partners. You can learn a lot about a surgeon based on interactions with a spouse, says Mr. Houser. Plus, spouses are often involved in the decision to join a new physicians group, especially if it requires relocation. So meeting the spouse also lets you introduce the spouse to the group. "You're buying and selling in this relationship," says Mr. Houser.

6 Open satellite offices
Figure out where your patients are coming from and expand your presence in communities where you have strong referral volume from optometrists. This lets you better serve your patients, who may make referrals to their friends and family. "You're making it easier for them to get to you," says Mr. Houser. St. Luke's has opened 4 satellite offices within a 40-minute drive from the surgery center and plans to open a fifth office this year. It's easier to be successful in areas where your center and its physicians are already known than to start from scratch in a new area, says Mr. Houser.

Once you've identified a community, look for a visible location that's easy to get in and out of and offers the possibility for adequate outdoor signage. Former bank branch buildings often work well, says Mr. Houser. "They're usually in a good location with easy access." And in the current real estate market there are many good deals out there.

Once the satellite office is ready to open, work on becoming part of the community. This should include advertising on billboards and in local publications as well as hosting health fairs. Get the sub-specialists out to the satellite offices to become part of the community, too, says Mr. Houser.

7 Stay open during expansion
Expanding your eye surgery center will give you the capacity for further growth and efficiency, but you need to make sure that the process of expansion doesn't bring your business to a halt. Delays in construction can easily grow from 1 week to 3 and wreak havoc on your surgical and staffing schedule. Whenever possible, stay open during construction, says Dr. Heersink. Surgeons and staff at Surgery Center South persevered through 18 months of jackhammers, dust and construction crews coming in and out of the building during the expansion from 2 to 6 ORs. "We never shut down the ORs for a single day," says Dr. Heersink.

The key to working through an expansion project is hiring a healthcare construction firm that understands the safety regulations for air exchange, filtering and humidity that surgical facilities must meet. "Make sure you're in constant compliance," says Dr. Heersink. Areas under construction need to be well-sealed from the rest of the center.

Regular communication with your physicians and staff is also important. Everyone should know how far along the project is and what to expect in terms of noise, clutter or disruption of services in certain parts of the building. Finally, plan the project in phases. At Dr. Heersink's center, once the new ORs were open, the old ones were closed so that they could be renovated as well.

8 Fill vacation blocks ASAP
Most physicians know months in advance when they're going on vacation, so you should, too. At the Roanoke Valley Center for Sight, schedulers call the physicians' offices and get physicians' vacation plans at least a month in advance. Once a block opens up, schedulers send out e-mails and a fax blast and call other physicians' offices to inform everyone about the opening. "The block time is gobbled up in no time flat," says Dr. Cotter.

9 Focus on safety
Just as important as bringing more surgeons and patients to your center is making sure that their experience is safe and efficient. Your center should have updated protocols and procedures that are followed during every case, says Mr. Houser. "If you're not doing that, then you're going to have a hard time growing." Good surgical outcomes and satisfaction are just as important to surgeons as they are to patients. It's what brings surgeons back to a busy eye surgery center.