Losing a key physician is a scary prospect for an ambulatory surgery center because it can mean taking a big hit in surgical case volume, says Mike Lipomi, president and CEO of Surgical Management Professionals in Sioux Falls, S.D. Here he lists six different ways physicians can exit ASCs and how to deal with each one.
1. Retiring physician. Physicians often plan their retirement three to five years in advance, but it is important to act early so that surgical volume will continue coming in. When you hear something, approach the surgeon directly. "If you have good rapport with the physician, it will be easy to be direct," Mr. Lipomi says. "You can say, 'I hear you are looking at retiring. What are your plans?' " Typically, the physician will want to bring in a younger partner to take over the practice. The ASC's concern is whether the younger physician will keep up ties with the center.
The new physician may, in fact, want to do things entirely differently, such as using an inpatient setting or another surgery center where he has a friend. It is important to have a discussion before any commitments are made. "The ASC should immediately be starting to work with the new doctor," Mr. Lipomi says. The center can offer him shares in the center, preferably from the retiring physician, and services like highly sought-after block times, access to preferred supplies and the surgeon's choice of staff. Unfortunately, however, "an ASC will often focus on the needs of the older, stable physicians who've been there and overlook the younger guys," Mr. Lipomi says. But if the younger physician commits to the ASC, "your volume may never slow down and, in fact, may pick up a little, because he will be more active," he says.
2. Retirement in a split practices. When physicians in one practice are split between two or more ASCs, the retirement of one of the physicians affiliated with your ASC can be tricky. The danger is that your physician's patients could be transferred to one of the physicians using another ASC. To preclude this, "you have to be doing some very focused recruiting of the other doctors," Mr. Lipomi says. The retiring physician could be enlisted for support.
3. Physician leaves town. Sometimes a physician decides to move to a whole new location, putting his ASC's volume up for grabs. He can't take those patients with him. "We had a doctor who, with very short notice, decided to join the Navy," Mr. Lipomi says. "We asked him what would happen to his practice, and he said 'I don't know and I really don't care.' That's when we knew we had to do something." The ASC stepped in and facilitated an acquisition of the practice by another local physician. In a phased-in acquisition, the acquiring physician may pay all of the practice's overhead, allowing the exiting physician to wind down without incurring debts.
4. Sudden death. Aside from the personal loss, the death of a key physician can be can be very troublesome for an ASC, particularly if the deceased physician was a solo practitioner who had no one lined up to give the practice to. In this case, someone from the ASC should call the physician's widow and ask if she needs any help dealing with the practice. Arrange for physicians affiliated with your ASC to acquire it. This process should move quickly, in perhaps three to four days, Mr. Lipomi says. If it is drawn out, the patients start finding new physicians on their own. "Patients and referring physicians have needs," he says. "As soon as patient patterns change, they won't come back." The physician who takes over the practice also needs to make sure he is contracted with the deceased physician's major payors. If not, he can usually get temporary permission to use the physician's insurance ID.
5. Physician loses his license. If a physician is charged with fraud or loses his license, the surgery center is not only embarrassed but can lose a great deal of volume. In this case, however, the ASC should move slowly and cautiously, Mr. Lipomi says. "These can be horrible situations," he says. "The feds may come in and close down his office and everything is a mess. Things will be in flux for a while, so it's important to lay back until the matter plays its course and then step in." It may not be possible to sell the practice until certain regulatory matters are settled.
6. Physician goes into rehab. When the physician steps down from his practice for several months to deal with a drug or alcohol problem, other physicians need fill the breach to make sure his patients are retained. This can also apply to disciplinary actions where licenses are suspended for a limited period of time, such as six months to a year. If would be overwhelming for one physician to take over the volume of another practice even temporarily, but five different physicians could do it, Mr. Lipomi says. "Each physician would get one in every five patients, which is workable," he says. Again, the ASC acts as a catalyst, bringing these physicians together to meet the problem.
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