A Planning Playbook for Opening a New Orthopedic ASC


Interest is at a fever pitch, but success is far from a sure thing.

The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature. The lower cost of ortho care in an ASC setting is driving a surge in investment, as treatment costs approximately 40% less at ASCs than at HOPDs, according to research from the Rothman Orthopaedic Institute in Philadelphia.

While interest in orthopedics is red hot, opening a new ASC isn’t as easy as it seems. Owners need to consider their long-term plans when opening a new orthopedic center, and much strategic planning is required.

Avoiding a ‘big mistake’ build

Lisa Austin, RN, CASC, is a healthcare consultant for Avanza Healthcare Strategies, an ASC and healthcare advisory organization in Westchester, Ill., that supports healthcare organizations in planning, developing, executing and operating ASC and outpatient strategies. She recalls working with a center that was built without a book of business lined up — a big mistake. “They thought if they built it, people would just come,” says Ms. Austin. “It turned out to be a huge failure.”

Ms. Austin says owners of ASCs that are undergoing planning and development benefit when they’re surrounded and advised by people experienced in opening new centers. Owners must also reach out to payors and bring good data to the project.

In some cases, prospective owners may crunch the numbers only to find that opening a new ASC doesn’t even make financial sense. That’s why those investigating and planning new ASC builds must be honest not only with key stakeholders but also, ultimately, themselves. “Before you build, ensure the business plan is as accurate as possible,” says Ms. Austin. “We’ve seen people manipulate plans to make success seem guaranteed, but this never works.” Assuming your research dispels these existential concerns, here are some aspects of a successful ASC build to keep in mind as you move forward with your plans.

Staff with ‘ASC mentality’

Experts recommend leaders follow a common playbook for new ASC success. Assemble appropriate staff as soon as you can. Contact your surgeon stakeholders to ask if they can help recruit any of their valuable former employees.

Be careful and deliberate about staffing. Your new hires should align with ASC culture, which differs from hospital culture. Specifically, you want staff who are cross-trained, or who aren’t cross-trained yet but open to the idea of performing tasks that might be out of the comfort zone of someone accustomed to operating in a narrow silo. The reason this is so important is that, at an orthopedic ASC, employees often need to do a little of everything beyond the core competencies with which they joined the center.

Brunswick Surgery Center in Leland, N.C., is a prime example. This year, it became the first ASC in the nation to achieve a designation as a Center of Excellence in all four orthopedic subspecialties (Advanced Hip & Knee Replacement, Advanced Spine, Advanced Shoulder, and Advanced Foot & Ankle Surgery) from DNV an accrediting agency that is recognized by CMS. Administrator Cindy Burleson, MBA, says her center focused on hiring employees who had the right mentality, particularly in terms of building the culture of premium customer service the ASC desired. “We want to have the plastic surgery employee culture for orthopedics,” she explains.

Ms. Burleson says the ASC ensures it hires the right employees by basing interviews on behavior-based questions that don’t focus on standard topics such as likes, dislikes, strengths and weaknesses. She says that such a traditional approach doesn’t work for her ASC. Instead, interviewers ask candidates about their past work experiences and performance, and steer the conversation into situational scenarios. Her team asks questions like, Tell me about a time when your performance was below standards and how you corrected it.

“You can tell a lot about someone based on how they answer that question and if they have a more negative or positive attitude toward work,” says Ms. Burleson. Her team also leans heavily on peer interviews, which gives the rest of the ASC’s staff input on who does and doesn’t get hired. “If the staff has a hand in who gets hired, they will invest more in that person’s success,” she says. Another essential consideration in staffing a new ASC is flexibility right from the jump. Ms. Burleson advises leaders not to hire too many new employees if the patient volume isn’t high enough yet. “Start with a smaller staff and adjust as your center’s business ramps up over time,” she says.

Outfitting considerations

Equipment is changing rapidly in the orthopedic world, and new ASCs must focus on what their surgeons want and need — within reason.

Ms. Austin notes that equipment costs average around $1 million per operating room. Refurbished equipment can keep costs down, but even the cost of pristine new gear can be negotiable. By building strong partnerships with vendors, ASC owners can often score rebates or favorable financing options — including payment plans — on brand-new equipment.

Some equipment for orthopedic ORs can be rather large, so ASC builders need to account for the footprint of equipment in the design of the new center. Ms. Austin often works with skeptical architects and owners who are sensitive to ORs looking “too big,” but she assures them they frequently need to be large at ortho ASCs.

Don’t focus exclusively on the size of your ORs. Consider the space you devote to other crucial areas like the sterile processing department, especially in terms of future volume growth and the types of equipment you may purchase down the road. Ms. Austin recalls working on one new center that skimped on the SPD area. “It was too small,” she says. “Ten years later, they’re making it work, but they still complain about it.” While Ms. Austin says it’s overkill for an ASC to build an SPD area the size of one typically found in a hospital, she urges centers not to trap themselves with a configuration that is too small. “Build in flexibility to the SPD area so it can increase in size over time,” she says.

Renovate or build from scratch?

CAPITAL CRUNCH Facility leaders must balance their surgeons’ equipment wish lists with their own critical budgetary objectives.

Although developing and building a new ASC from the ground up can provide the most value for owners’ money, it’s vital that the footprint is just right. Keeping some space reserved for future growth in a new build is a good idea, says Ms. Austin, who recalls a project she helped facilitate in Texas. The new center opened with three ORs, but the project architect’s blueprint gave the ASC the option of bringing a fourth OR online later with little disruption. The center has since expanded and is utilizing the fourth OR.

Not all ASCs enjoy the option of a new build, however. Sometimes renovations to an existing space are all that’s available in a given location. In this scenario, the build team should closely examine the space to determine how difficult or expensive it would be to get it up to code to operate as a surgery center, while also ensuring the space has the necessary space to keep your clinicians, staff and workflow has the room to operate comfortably while providing a superior patient experience.

‘Never enough space’

Brunswick Surgery Center was built from the ground up. It occupies the first floor, while the building’s owner uses the rest of the space. Four ORs were built, but Brunswick didn’t outfit the fourth OR at first. Once it had enough case volume, that unused OR was outfitted and brought online. Today, it’s constantly humming with activity. The center also built two flex rooms for pre- and post-ops. These flex rooms have changed as its case volume has grown.

Brunswick Surgery Center plans to build further at its current location. The fact is that the ASC has grown so rapidly that its current space simply isn’t large enough. “We can build additional space into our structure because we have enough land availability, parking and access,” says Ms. Burleson. Remember: Just because demand for ortho ASCs is at a fever pitch, patients won’t automatically appear when you open the doors of your new ASC. By carefully considering the many important elements that go into building an optimal orthopedic ASC, developing a solid business plan and learning lessons from centers that have thrived, however, you’ll likely have a leg up on success. OSM

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