But soon the center did. An orthopedic group that had been
doing a large number of cases at Harrison saw a chance to get in
on the action by opening its own outpatient center. "A second
orthopedic group came in and helped make up for that," says Ms.
Biedermann, "but ultimately they opened their own center, too."
Still, portions of the dwindling revenue continued to be distrib-
uted to retired surgeons. The burden eventually became too
heavy to sustain, and in 2010 the center closed. A month later, it
was acquired by Upstate University Hospital, where Ms.
Biedermann is now the clinical manager. The Camillus center was
also sold. "Times change," she says wistfully.
Inequitable arrangements
It's a scenario that's played out again and again. Centers with
shortsighted ownership arrangements may thrive at first, but
eventually the initial flock of surgeons scatters and/or ages, and
the golden eggs begin to disappear.
"If one or a few doctors own a majority interest and get most of
the distributions, they have a hard time attracting new partners,"
says Jon Vick, president of ASCs, Inc., a Valley Center, Calif., con-
sulting firm that specializes in sales, strategic partnerships and
joint ASC ventures. "Then, as some of the partners start to slow
down, revenues and profits decline, and it gets even harder to
attract new physicians. Now the center is just breaking even, or
losing money, and nobody wants to buy in, so it closes."
About 100 ASCs close every year, says Mr. Vick, many because
they fail to recruit new physicians and ultimately can't find buyers
(see "ASCs Now Rising and Falling at the Same Rate").
The people bringing the cases have to have an adequate incen-
tive, says Jeff Péo, chief development officer for management
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