The River Valley Ambulatory

Surgery Center – Norwich, CT

Richard Martin, MD, DMD, FACS,
Medical Director, River Valley Ambulatory Surgery Center, LLC

Escalating costs have put healthcare squarely in the cross hairs of both state and national politicians. As a result the
landscape of medicine has shifted and we are now growing accustomed to its rapid change. The once foreign idea
of physician employment is now becoming a trend in hospitals. Increasing governmental regulations, and decreasing
insurance coverage and reimbursement, are a reality. Collectively these changes have led to a progressive erosion of
t patient an practiti ner in epen ence r sur e ns an t eir patients, am ulat r sur er centers A Cs er
a means to regain some of the control and autonomy previously lost to hospital bureaucracy.

Twenty years ago when I started my practice in Norwich the warning signs of this future were there, albeit much less
evident. At that time ASCs were few and far between in New England and well under the ‘radar’ of both insurance
and hospital administrators. However, while completing my surgical training in Seattle I noted that they were becoming
increasingly more common place throughout the West Coast. When I opened my practice in Norwich I had two
options to consider: whether to set up an independent ASC, or to join a regional hospital. After contemplating the
pros and cons I found the decision to be an easy one.
At the time my list looked like this:

1. Independence:
Pros – By having a free standing ASC I was
providing myself with a separation of church
and state so to speak (independent physician
practice from hospital administration). After all,
freedom is what we all seek.
Cons – Independence, as my college age children are
fin in ut, rin s it it reater resp nsi ilit an
greater cost. I alone would have to make certain
that all standards and guidelines were met. The
expense and associated risk of constructing and
utfittin an A C ul all s lel n me
2. Control:
Pros – Within the standards of care I would be
able to set my own policies and procedures and the
means of their implementation. I could hire and
train a sta t cl sel ali n it m elie s an t e
needs of my patients. I could dictate OR scheduling
and eliminate delays.
Cons –If an adverse event occurred there would be
no layer of bureaucracy to hide behind. The buck
stopped solely with me.
3. Pricing:
Pros – I saw hospitals in general as ‘cumbersome’
organizations that like most large businesses
have many layers of red tape. By simplifying things
c ul er t e same services at a reatl re uce
cost and thus make it accessible to more patients.
After all, isn’t this supposed to be the ultimate goal
t e A r a le Care Act
Cons –Given my small size would I be able to create
enough volume at a lower cost to support the
expenses of an ASC?
4. Environment:
Pros – I felt that I could develop a facility that was
‘less clinical’ in appearance, and overall more
friendly. In other words I could design my practice
t e m re patient riente , an specificall tail re
to my surgical preferences.
Cons – On this point I saw few, if any, negatives.
continued on page 7

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Over the past twenty years I have fully realized that my list of pros and cons were on point. Although there have been
many ups and downs I never regretted the decision to set up an independent ASC, nor the work that it entailed. In
2013 when presented with the opportunity to expand and involve other surgeons from the community, I reviewed the
a ve list an nce a ain pte t pr cee u ul sacrifice s me in epen ence ul e ali ne it
like-minded surgeons who also desired greater freedom from the hospital setting. The ‘con’ of greater cost was still
there, but now spread out over a larger cohort. Though I would be giving up some control, decisions would be made
by physicians, not administrators.

With regards to pricing, on average ASCs are able to provide the same quality surgical care as hospitals, but at
approximately only 53% of the cost amazingly, despite the savings, insurance companies and the government are still
resisting contracting with, and permitting the development of, ASCs). Nationally this equates to an estimated cost
re ucti n illi n llars annuall , it patients savin nearl five illi n in l er c pa s astl , in re ar t
envir nment fin t at ur A C River alle A C, C t e a muc calmer, entler place t perate Apparentl ,
our patients agree as we have a nearly 100% satisfaction rating, compared to hospitals which hover around only
a 70% rating. Along with this, ASCs can boast an average infection rate of .1% versus hospital outpatient settings
which are as high as 2% on average. Currently River Valley Ambulatory Surgery Center, LLC is a partnership of
24 surgeons involving nearly all surgical specialties. g

Editor’s Note:
Hooray for Dr. Martin and colleagues, risk takers and entrepreneurs. Returning control, responsibility and income to physicians
who have invested their lifetime in pursuit of the best possible patient care must be extremely satisfying. I am hopeful that the
decentralization of healthcare will truly result in cost efficiencies, better value for the consumer, and stabilized incomes for doctors
and nurses. I am fearful that Wall Street will figure out a way to capitalize on business ventures like this, siphoning off dollars to
hedge fund investors. Regardless, Dr. Martin’s example is a clarion call for all of us to put on our business hats!

-Dennis Slater, MD

T HE O P E N J O UR NAL • F AL L 2017 -7-