The Complex Journey to Launch an ASC

Tri-City Cardiology relied on focused partnerships to bring surgical care closer to its patients.

Launching a new ASC requires deft coordination among a variety of partners. No matter how specific your circumstances or ambitions may be, the key to success for any ASC project is leaning on the right set of partners, and working in harmony with the lawyers, regulatory agencies, capital equipment vendors, insurers, architects, designers, physicians, consultants and other stakeholders you need to get the job done right.

Variety of vantage points

These vital partners fill in the knowledge and expertise gaps that administrators and physician-owners may lack. Tri-City Surgical Center is a prime example of how these partnerships can lead to a successful ASC launch.

In January, Tri-City Cardiology, a group of 28 board-certified cardiovascular specialists and 11 advanced practice providers, opened Tri-City Surgical Center, a 15,745-square-foot, four-OR, cardiovascular-focused freestanding ASC in Mesa, Ariz. Currently, the ASC provides cardiac interventional procedures including heart catheterizations, cardiac angioplasty and cardiac stenting, and electrophysiology procedures such as cardiac pacemaker and defibrillator implantations, generator changes and loop recorder implants. It also provides peripheral procedures including peripheral angiography, angioplasty and stenting.

Established in 1979, Tri-City Cardiology operates multiple office locations in the Phoenix area and is affiliated with both Banner Health and Dignity Health hospitals for inpatient services. Jaskamal Kahlon, MD, FACC, a board-certified physician who specializes in cardiovascular disease, echocardiography, interventional cardiology, internal medicine and nuclear cardiology, says he and his Tri-City partners saw an opportunity to bring procedural and surgical care closer to where their patients live.

“Maricopa County is the fastest-growing county in the whole country, with the fastest-growing population of retirees,” says Dr. Kahlon. “We’re studying who our patients are, and they do not want to travel more than 20 miles for care,” he says, adding they also prefer ASCs over hospitals because of patient safety and infection prevention reasons, as well as a more streamlined, personalized experience, more predictable scheduling and quicker discharges.

Dr. Kahlon says Tri-City patients have enjoyed their experiences at the ASC so far. “Patients love it,” he says. “They see the familiar faces. The employees know they’re working for the doctors and not for the hospital. It’s a totally different experience.”

Benefitting from outside expertise

The Tri-City ASC project began in 2018 as regulators started to embrace the idea of moving certain cardiovascular procedures out of hospital environments. “We started having meetings to come up with logistics and the legal framework on how to set this up,” says Dr. Kahlon. “We took multiple opinions from different law firms to make sure the legal ground was sound.”

Tri-City Cardiology CEO Ken Frandsen and Chief Operating Officer Angela Szczublewski consulted — and got valuable ideas from — administrators at other area surgery centers. Then they bolstered that knowledge by hiring a professional consulting organization for additional insight. “They were very knowledgeable and very helpful with regulations and commission requirements,” says Ms. Szczublewski. “They had an architect who helped us design the center and a clinical nurse who was very helpful in setting up the policies, procedures and protocols we needed to successfully pass the state licensure and Joint Commission.”

These consultants guided Tri-City stakeholders through a complex regulatory process. “Once we took the certificate of occupancy, we quickly got state inspection, which then allowed us to begin our test cases for Joint Commission and CMS certification,” says Ms. Szczublewski.

The experience taught Ms. Szczublewski the importance of leaning on accreditation agencies, as the Joint Commission itself proved an invaluable resource. “The tools and resources they shared through the process, and the portal access we had to documents and regulations, were most helpful,” she says. “They really prepared us for subsequent inspections, and the operations of the ASC.”

Vetting the vendors

Cardiovascular ASCs need fixed C-arms — a costly capital expenditure that requires careful analysis skills and negotiation savvy. Tri-City bought two for the Mesa ASC and leaned on its consultants during the negotiation process to vet various vendors.

The C-arms were purchased early in the planning process, which was crucial both in terms of garnering buy-in from physicians and for design purposes. “It had to dovetail with the architectural plans, because almost every C-arm has its own unique requirements which cannot be retrofitted easily,” says Dr. Kahlon. “They need to be purchased preemptively. Otherwise, it’s very expensive and laborious to alter your building plans, especially where the electrical fixtures will be.” Even small things like where the lights go, he says, can be a major impediment to doing procedures and must be put into play early on and in conjunction with other decisions. “Everything needs to move in tandem,” says Dr. Kahlon. “None of these things can be done in a serial fashion; they all have to be done in parallel.”

Fortune and fortitude

The site Tri-City chose was a combination of fortune and a desire to build from scratch. “We vetted many options along the way, and none seemed to be the right one until we found this piece of land that just happened to be available,” says Ms. Szczublewski. “We were able to build from the ground up, and the site offered convenience in one of our larger market areas.” She adds that trying to retrofit an existing building and meet the building codes and requirements for an ASC relative to the infrastructure, the HVAC and the electrical requirements would have cost a lot.

Patience required

Tri-City encountered delays — some related to licensure inspections and equipment deliveries, but also difficulties its vetted contractors had in procuring building materials. But perhaps its biggest hurdle involved CMS. “Receiving our PTAN (Provider Transaction Access Number) was probably the longest delay we saw,” says Ms. Szczublewski. “Luckily, we were hybrid, so we could start doing OBL (office-based lab) cases while we were waiting to get everything lined up for the ASC side of the facility.”

Dr. Kahlon advises leaders to steel themselves for timeline shifts. “You need to know going in there can be a significant delay of two to six months until you can do Medicare procedures in the ASC,” he says.

All told, it took eight months for the new ASC to schedule its first Medicare patient, but now the center is off and running. Ms. Szczublewski’s advice to her peers? “You need to know what your strategic plan and ideas are, and what you want as the end result,” she says.

By partnering with the right experts, Tri-City was able to create an ASC its physicians and patients have wanted for some time. OSM

Note: This three-part article series is supported by Stryker.