Editor’s Page: Keep the Independent Spirit Alive

The black and white photo is faded, but it’s easy to make out the wide smiles of anesthesiologists Wallace Reed and John Ford. The two men are shaking hands at a banquet table to celebrate the opening of SurgiCenter, the first independent ASC in the nation, which began caring for patients on Feb. 12, 1970. Neither man could have imagined what would become of their revolutionary idea to provide cost-effective, same-day surgical care outside of hospitals. Today, more than 5,000 ASCs across the country perform 23 million surgeries each year.

In February 2020 — 50 years after SurgiCenter opened — Banner Health in Phoenix announced the planned reopening of a larger facility in a towering edifice on the northeast corner of its campus. You wonder what Drs. Reed and Ford would think if they were alive to see their vision of independence taken over by one of the largest hospital systems in the country.

When I began writing for this magazine in the mid-aughts, scores of surgeons were striking out on their own to build ASCs and battle local hospitals for a big slice of the surgery pie. Today, the very hospitals that fought back are realizing the inevitable growth potential — and money to be made — in the outpatient space and are buying up physician practices, obtaining majority shares of physician-owned surgery centers or building their own state-of-the-art ASCs.

Last month, I spoke to the administrator of a formerly physician-owned ASC that was caught in the wide net cast by Tenet Healthcare and its subsidiary United Surgical Partners International, which acquired 86 surgery centers in November 2021. The deal was part of a larger trend discussed in our look at the current state of freestanding ASCs, beginning on page 16. She said her center’s physician-owners built their facility because they wanted complete control over the care they provided. They had skin in the game and were willing to invest in whatever equipment was necessary to give their patients top-quality care without worrying about how many beans were being counted in a hospital boardroom. She’ll be curious to see what happens when one of the former physician-owners asks for a specific knee implant, but is told to go with what’s used across Tenet’s system of ASCs.

In the meantime, the administrator is adjusting to no longer running a mom-and-pop shop. She attends virtual meetings with hundreds of colleagues she’s never met. She no longer yells into the surgeons’ lounge to get quick approvals for petty cash purchases. To hire the local bug exterminator who has charged her $85 every six months for the past 15 years would have required a six-step vendor vetting process. 

There are definite pluses to being part of a national network or large health system. Tenet’s purchasing power allowed the administrator to score a great deal on a video monitor for which she’d been unsuccessful in negotiating on her own. Surgeons and their staffs are maintaining autonomy in jointly owned ASCs, and plenty of hospital leaders understand the importance of keeping the essential elements of outpatient care intact. Still, you have to wonder if the intangibles that made ASCs thrive will be lost if more physician-owners decide to sell their shares.

SurgiCenter’s empty shell sits across the street from its replacement, its name still displayed in red block letters on the façade. But the heart, soul and guts of the facility that turned the surgical industry on its head are long gone. There will be continued interest in developing new ASCs and funding current facilities. Let’s just hope the industry doesn’t lose the independent spirit of the two pioneers who dared to disrupt how surgical care is delivered. OSM