Tom Yerden, CEO TRY Health Care Solutions LLC

Presented to: 7th Annual Orthopedic, Spine & Pain Management Conference

Introduction   Managed ASMG Outpatient Services, San Diego   Developed 70 ASCs   Among First to Advocate MDA Ownership in ASCs   Developed “ASC Management Triangle” Concept

“ASC CONSULTANT”

One who takes your watch, tells you what time it is,

Then keeps your watch,

And bills you for it!!!

Tip #1: Make all your mistakes before you did the hole!

Formation of an Ambulatory Surgery Center Enterprise

Pre Operational Phase First Patient

Formation of Operating Entity

Development & Implementation Phase

Feasibility

Operational Success

Surgery Center FailuresMore than 30% are underperforming

I. Traditional Model

II. Employment Model

III. Corporate Model

1. Financial Management

2. Clinical Oversight

3. Enhancing Enterprise Value (Growth)

4. Coaching, Refereeing, & Mentoring

  Start up → Adolescence → Maturity (CashFlow) (Growth) (ROI)

1. Establishrealisticbudgetwithstaff&physicianinput Mostbudgetsarewhatpaleontologistswouldcall“disarticulated”

2. Limittheinformationyou“manage”(“Dashboard”)3. Communicateyourperformanceagainstobjectiveswith

thosewhocanimpacttheresults4. Rewardachievementsagainstbudget:“physicians

shouldnotbetheonlyone’sgettingadistributioncheck!”

5. Remember:“Budgetsarefluiddocuments”

The ASC “Management Triangle”

ClinicalDirector

MedicalDirector ExecutiveDirector

Core Responsibilities & Concepts:

  Don’t allow profitability to trump quality of care   Don’t take quality of care for granted   High marks on pt. questionnaires ≠ excellence   Allow your Nursing Director to act independent of executive

director   Solid financial “margins” support quality “mission”   Quality of care and outcomes will take center stage in 2009

and beyond   Active Medical Director Role is Key!

Core Responsibilities & Concepts: (Define Enterprise Value)

  YourprimaryobjectiveasanExecutiveDirectoristoenhance(increase)theenterprisevalueofyoursurgerycenter(1)

  Whatisyourmarketshare?Whatshoulditbe?  Whoisyourcustomer?  MyGoals:AscommunicatedbyAspenBoardofDirectors 1. Addonenewsurgeonperquarter 2. Meetpersonallywithtoppayorsannually 3. Increaseprofitmargin/caseby15% 4. Increasecashdistributionsby18%(toaROIof34%)(2) 5. ReduceL‐TDebtby12%

(1)Withoutimpactingqualityofcare(2)Whatisyourcashdistributionpolicy?Retainedearningspolicy?

1. Internal & External Marketing Efforts 2. Seek Feedback 3. Report Progress Against Expectations 4. Networking – TRY Solutions Float Trip

  Start up →

1. Ownership (not a safe harbor) 2. Board representation 3. Compensation 4. Medical Directorship Compensation (up)