to have it on-site or have a vendor that can get it to you quickly. We
try to have a primary vendor, but that doesn't cover everything.
Supplies aren't always available on a moment's notice, so we work
with many vendors."
Extensive pre-planning also lets the San Antonio surgery center take
on a lot of cases that most ASCs won't touch. "We've carved out a lot
of procedures that maybe aren't approved on an outpatient basis but
that our surgeons and the medical director of that payer think it's safe
to do," says Mr. Bullock. "For example, a distal radius fracture broken
in 3 or more places is not on the ASC-approved Medicare list, but
we've carved that out with payers, because from an orthopedic stand-
point, it doesn't matter if it's fractured in 2 places or 3."
Negotiate as many carveouts with insurers for as many procedures
as you think you can safely perform, says Mr. Bullock. "Obviously, you
can't do it when the patient is there waiting," he says. "You have to
have some forward thinking. Get a list of procedures you can com-
fortably do and have them all ironed out ahead of time."
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