While some independent ambulatory surgery centers may be placing a joint venture partner as a high priority, many ASCs have already established strong partnerships with a hospital and management company. “There is more pressure than ever to maintain these relationships,” says Nap Gary, COO of Regent Surgical Health. Here are five initiatives leaders of joint venture ASCs should be pursuing in an effort to position their centers for success in 2014. Reimbursement improvement Payer contract negotiation is one of the main attractions hospitals offer as a joint venture partner, but gaining improved reimbursement is an ongoing process. “One of the fundamental elements of ASC strategy is looking for opportunities to improve reimbursement,” says Mr. Gary. At least on an annual basis, ASC leaders should revisit payer contracts and constantly be aware of upcoming contract expirations. Specialty mix examination The physician market place regularly changes, new procedures gain approval for the ASC setting and patient demand for specialties shifts. Spine is a relatively new and optimal specialty for the ASC. In some Regent centers, Mr. Gary has observed the chance to bring spine and general surgery to the table in contracts that largely focused on pain and GI. New procedures add diversity to an ASC’s specialty mix and open the door to previously untapped sources of revenue. Alignment of purchasing Hospitals often have purchasing power that exceeds that of a surgery center or management company, but all supply purchases should be carefully analyzed. “Align purchasing where the most savings can be achieved,” says Mr. Gary. Some purchases made through the hospital could translate into greater savings if purchased through the management company. New physician ownership New physician investment is an excellent way to promote ASC/physician engagement, but three-way joint venture ASCs must consider all partners before taking on new investors. “Bringing on new physician owners is different when a hospital is involved,” says Mr. Gary. “Flexibility is not unlimited.” Hospitals often have a majority stake in an ASC, a stake that remains unchanged as new owners come on board. New physician investment will serve to dilute the ownership of existing partners. As a result, new physician investment becomes opportune as partners leave the center or retire. Market awareness ASC leaders need to ask: “Is this the optimal position in my market?” says Mr. Gary. As the rollout of the Patient Protection and Affordable Care Act continues, the ASC leaders that constantly monitor their markets for emerging changes and opportunities, such as the possibility of ACO alignment, will find their centers among some of the most successful providers.