January/February 2009 Vol. 2009 No. 1 50 Management Will the Federal and Development Government Shut Companies to Down Surgery Centers Watch for 2009 and Physician-Owned his article briefly highlights 50 companies that are active in ASC Tmanagement and development. Note: This list is not an endorsement Hospitals? of any company. To see more information regarding ASC chains, see "10 By Scott Becker, JD, CPA, and Elaine Gilmer, JD Interesting Facts About Surgery Center Chains" on p. 50. s the Democrats take control of the House, the Senate and the Ambulatory Surgical Centers of America (ASCOA). Presidency, many question the impact of such a change on ASCs and ASCOA rigorously helps its partners achieve outstanding results. The Aphysician-owned hospitals. The most significant question is: Will the company was formed by Brent Lambert, MD, FACS, Tom Bombardier, federal government shut down and/or restrict physician-owned hospitals MD, FACS, and George Violin, MD. Its senior leadership team now also and ASCs? includes CEO Luke Lambert, CFA, and CFO Robert Westergard, CPA, as well as several others. The company has grown to be one of the best The short answers to this question are: privately-held ASC chains in the country. It currently operates 25 surgi- 1. no, the federal government will not shut down ASCs; and cal centers in many different states. Its typical model includes a minority 2. maybe the federal government will halt the development of new physician- ownership interest plus a management and development agreement. owned hospitals and/or restrict the activities of and adopt new rules relating ASCOA is one of the most highly competent companies in the ASC to existing physician-owned hospitals. arena. It focuses on turnarounds and new centers. www.ascoa.com A story of numbers and politics Ambulatory Surgical Group (ASG). ASG was founded in 2008 by Currently, there are approximately 5,800 ASCs in the United States. Of these, long-term ASC veteran John Seitz. John has founded this company with the approximately 900 are not Medicare-certified. Forty percent of all ASCs are intent of providing high level management consulting and development serv- continued on page 12 ices to ambulatory surgery centers. A key differentiator of the Ambulatory Surgical Group is the ability for physicians to own 100 percent of the equity INSIDE 5 Letter From the Editor: Recapping 35 Accounts Receivable Analysis for continued on page 6 2008, Looking Ahead to 2009 ASCs by Revenues From the VMG Health 2008 Intellimarker 14 17 Great ASCs to Work For ASC Communications, Inc. 37 4 Critical Concepts From the Latest PRSRT STD 16 Larry Taylor of Practice Partners 315 Vernon Avenue Stark Act Regulations US Postage Discusses 3 Trends for Surgery Glencoe, IL 60022 PAID Centers in 2009 40 Rob Carrera of Pinnacle III Discusses Merrill WI 3 Trends for Surgery Centers in 2009 54452 18 10 Steps to Prepare for and Respond to Anesthesia Subsidy Requests 42 10 Managed Care Best Practices Permit No 24 for Bariatrics, General Surgery 21 6 Critical Anesthesia Protocols and and Gynecology Procedures to Improve Efficiency 44 Peer Review Q&A With Sarah Martin 22 5 Current Challenges in Ambulatory 46 4 Observations on Orthopedic and Anesthesia Spine Devices and Equipment 25 5 Things to Know About Gynecology 48 3 Ways to Get the Most Out of in ASCs Generation Y 26 CMS Establishes New ASC 49 OIG Blasts CMS on HIPAA Security Conditions of Coverage Gaps; Guidance for ASC Compliance 27 Update on Weight-Loss Surgery: 50 Election 2008: 5 Quick Observations 3 Current Trends 50 10 Interesting Facts About Surgery 28 ASC Medical Device, Equipment and Center Chains Supplies Product Shopper 51 6 Best Practices for Proper Disposal 32 Turnaround Case Study: Minor of Pharmaceutical Waste Issue or Fatal Flaw? 54 General Surgery Coding Guidance 34 Capture Your Partners’ Cases: for 2009 Additions and Revisions The Carrot & Stick 55 Resources 2 visit www.beckersasc.com Sign up for the Becker’s ASC Review E-Weekly at www.beckersasc.com 3 4 visit www.beckersasc.com January/February 2009 Vol. 2009 No. 1 Editorial FEATURES EDITORIAL 5 Letter From the Editor: Recapping 2008, 35 Accounts Receivable Analysis for ASCs Looking Ahead to 2009 by Revenues From the VMG Health Rob Kurtz Editor in Chief By Scott Becker, JD, CPA 2008 Intellimarker 800-417-2035/[email protected] 14 17 Great ASCs to Work For 37 4 Critical Concepts From the Latest Mark Taylor 16 Larry Taylor of Practice Partners Discusses Stark Act Regulations Senior Reporter 3 Trends for Surgery Centers in 2009 By Scott Becker, JD, CPA, 800-417-2035/[email protected] and Elissa Moore, JD 18 10 Steps to Prepare for and Respond Ariel Levine 40 Rob Carrera of Pinnacle III Discusses Reporter to Anesthesia Subsidy Requests 3 Trends for Surgery Centers in 2009 800-417-2035/[email protected] By Rob Kurtz 21 6 Critical Anesthesia Protocols and 42 10 Managed Care Best Practices for SALES & PUBLISHING Procedures to Improve Efficiency Bariatrics, General Surgery and Gynecology Jessica Cole By Andrew Ribaudo and By Susan Charkin President & Chief Development Officer Kelly Scherbenske, MS, MSN, CRNA 44 Peer Review Q&A With Sarah Martin 800-417-2035/[email protected] 22 5 Current Challenges in Ambulatory By Rob Kurtz Jamie Maltman Anesthesia 46 4 Observations on Orthopedic and Account Manager & Circulation Manager By Stephanie Wasek 800-417-2035/[email protected] Spine Devices and Equipment By Stephanie Wasek Annie Stokes 25 5 Things to Know About Gynecology Account Manager in ASCs 48 3 Ways to Get the Most Out of 800-417-2035/[email protected] By Stephanie Wasek Generation Y Scott Becker 26 CMS Establishes New ASC Conditions By Lt. Col. Bruce Bright, CCIM Publisher of Coverage 49 OIG Blasts CMS on HIPAA Security 800-417-2035/[email protected] By Stephanie Wasek Gaps; Guidance for ASC Compliance By Marion K. Jenkins, PhD Becker’s ASC Review is published by ASC Communications. 27 Update on Weight-Loss Surgery: All rights reserved. Reproduction in whole or in part of the contents without the express written permission is prohibited. 3 Current Trends 50 Election 2008: 5 Quick Observations For reprint or subscription requests, please contact By Scott Becker, JD, CPA (800) 417-2035 or e-mail [email protected]. By Stephanie Wasek For information regarding Becker’s ASC Review, 50 10 Interesting Facts About Surgery The Hospital Review or Becker’s Orthopedic & Spine 28 ASC Medical Device, Equipment and Practice Review, please call (800) 417-2035. Supplies Product Shopper Center Chains 32 Turnaround Case Study: Minor Issue or 51 6 Best Practices for Proper Disposal Fatal Flaw? of Pharmaceutical Waste By Jeffrey A. Peters By Rob Kurtz 34 Capture Your Partners’ Cases: 54 General Surgery Coding Guidance The Carrot & Stick for 2009 Additions and Revisions By Chris Bishop By Cristina Bentin, CCS-P, CPC-H, CMA 55 Resources Coming in the February special issue of Becker’s ASC Review: I Mergers and Acquisitions of Ambulatory Surgery Centers I Valuation of ASCs I Specialty focus: Ophthalmology To learn more about subscribing, authoring an article or advertising, please call (800) 417-2035. Note: Editorial content subject to change. Sign up for the Becker’s ASC Review E-Weekly at www.beckersasc.com 5 Letter From the Editor: We hope that 2009 will be a terrific year for the surgery center industry and business. We see Recapping 2008, numerous new evolving opportunities for surgery Looking Ahead to 2009 centers. We continue to see more surgery centers develop, and more finding new means to reduce The March/April 2008 was a remarkable year for surgery centers. costs, outsource certain operations and make dramatic improvements in their operations. In issue of Becker’s ASC 1) The Centers for Medicare & Medicaid many situations, we see surgery centers operating Services (CMS) officially changed payment in a smarter manner than ever before. Review will profile systems and rates for ambulatory surgical centers. We always welcome the feedback of our readers, 20 Great ASC our advertisers and our critics. Should you have 2) CMS implemented new conditions of any questions or have anything you would like Physician Leaders. coverage for surgery centers. to share with us, please email me at To nominate a great 3) The healthcare system moved to a point [email protected]. ASC physician leader, where there are more ambulatory surgery Very truly yours, e-mail Scott Becker at centers nationally than there are hospitals. [email protected] 4) There was a changing of the guard in Washington, D.C., which may have very substantial impacts on the long-term healthcare system. Scott Becker 5) There were a series of attacks by payors and states against out-of-network activity. P.S. We are hosting the 7th Annual Orthopedic, Spine 6) The nation faced a severe credit crisis that and Pain Management Focused Ambulatory Surgery stopped several surgery center projects in Center Conference from June 11 – 13 at the Westin their tracks and, overall, had a relatively Hotel in Chicago. Should you desire information small effect on day to day operations of about that event, please call me at 312-750-6016 or surgery centers but a much larger impact on email me at [email protected]. the transaction market for surgery centers and mergers and acquisitions nationally. ASC COMMUNICATIONS & AMBULATORY SURGERY FOUNDATION Come hear Uwe Reinhardt, PhD, the 32nd most powerful person in healthcare as ranked by Modern Healthcare, speak about the future of healthcare at the 7th Annual Orthopedics, Spine and Pain Management Focused ASC Conference Improving Profits and Business and Legal Issues *** JUNE 11 – 13, 2009 WESTIN HOTEL • CHICAGO, ILLINOIS For more information, call (800) 417-2035 visit www.beckersasc.com, or e-mail Scott Becker [email protected] Jessica Cole [email protected] 6 visit www.beckersasc.com 50 Management and Development Companies to Watch for 2009 (continued from pg.