DISC’s founding director, Robert Bray.TriasMD, the company behind DISC Surgery Centers, is opening a new outpatient surgery facility in San Diego that will specialize in spine, orthopedic and pain management care. The 12,000-square-foot center will feature operating suites equipped with advanced imaging, navigation and robotic technology.
The facility adds to the several spine, orthopedic and pain management facilities DISC operates across California. TriasMD is an ambulatory surgery center (ASC) management company.
Many well-known specialists across spine, orthopedics, anesthesiology, pain management, vascular surgery and plastic surgery have already committed to practicing at the new center, DISC’s founding director, Robert Bray, told Ambulatory Surgery Center News.
ASC News caught up with Bray to learn more about the new center – and what might be next for DISC. Highlights from that conversation are below, edited for length and clarity.
ASC News: Can you walk me through the backstory of how this center came to be?
Bray: Three years ago, we merged with TriasMD, which is a company I set up that became part of Chicago Pacific Founders (a private equity company). The goal was to expand, to take our model and scale it. We’ve been in the process of expanding throughout California. When we look at regional areas, North County San Diego is a natural choice. There are many unique factors to consider, like population density, payer mix and the characteristics of the region.
We chose a tough market to start with, beginning in L.A., where we faced big-name competition from hospitals, and Newport Beach was also challenging because of Hoag’s dominance for years. North County San Diego was a natural next step. No one had consolidated referrals there, and most things were centered in San Diego proper. I went to college in that area years ago, and we own property in San Marcos, so I know it well. The doctors in North County are very good, but most are independent or affiliated with hospital systems in San Diego, while North County itself has grown into a large, high-end community.
Our new center in Carlsbad is untapped for the type of high-acuity spine procedures we do. DISC is very different from a general ASC: We focus on high-acuity musculoskeletal cases, including spine, knee, hip and shoulder replacements. We do fewer cases per day, maybe seven or eight, but these are more complex and deliver bigger cost savings to the system.
Our approach wraps everything – surgeon, assistant, anesthesia, the facility, implants, monitoring – into a global price, which is more efficient and results in better outcomes. By improving quality, we can shift the payer mix and realize larger margins, especially on higher-acuity cases.
We started with just Newport Beach, then built a brand-new facility in Marina del Rey last year, which is growing quickly. We also purchased a center in Thousand Oaks, which is thriving, and we have smaller centers in Valencia and Walnut Creek.
Those smaller centers help us test new markets, because even with the same insurance, contracts differ by region. Our plan is to see how the smaller centers perform and then possibly build larger ones. Overall, we’re expanding top to bottom in California. We’re likely to open two or three more in the state, focusing on the right population areas. After that, we’ll look out of state, possibly as far as the East Coast. Now that Carlsbad is open, we have five operational centers, and we could easily double that number in the next few years.
We look at three verticals: buildings and sites, payer contracts, and doctors. If there are enough doctors in an area, we tackle the contracting piece (we’re mostly an in-network model), which includes surgeon reimbursement, anesthesia and everything else. We take work off physicians’ plates – like negotiating contracts –so they aren’t forced to accept sub-Medicare rates on their own. By bundling the entire procedure and working directly with payers, we create a win-win for everyone.
Tell me more about the DISC model.
The model is “high acuity in an outpatient environment.” That lets us deliver much larger cost savings because higher-acuity hospital procedures are expensive. We globalize the entire event of care, from when the patient walks in the door to when they walk out, including all fees. The resulting efficiency increases quality and reduces costs, so both payers and patients benefit.
We’ll continue to expand in California. As I mentioned, we already have centers in Newport Beach, Marina del Rey, Thousand Oaks, Valencia, Walnut Creek and now Carlsbad. Our data-driven approach and experience with payers give us a solid foundation. It’s about finding the right markets, negotiating contracts and ensuring enough doctors are on board. We’ve been talking with payers about where they want to see increased outpatient migration. If you check back in four to six months, we’ll likely have another four or five sites finalized.
With your model focusing on higher-acuity procedures, what, if any, impact do you see from site-neutral payments?
It would be great if rates were equalized with HOPD (hospital outpatient department) rates, because hospitals usually get higher reimbursement. But we already operate with what we have. Our efficiency is high; we know our data, our costs and our low complication rates. As we scale – doing hundreds, then thousands of spine cases, plus hundreds of joint replacements – we can negotiate better prices for equipment and supplies. The payers see improved outcomes at a lower cost, and that helps them sell their products. Patients get a single copay or deductible, and everything is wrapped in.
You mentioned that you’ve brought on some of Southern California’s top physicians. How did you round them up, and what do you think drew them to work with you?
We jokingly call it “herding cats.” It’s a challenge, but once physicians see the advantages, they understand. We have state-of-the-art technology – microscopes, robots, imaging, guidance – all in a beautiful facility. We also provide business support: contracting, HR, marketing and more. Doctors can focus on practicing medicine instead of managing those details. They typically join by bringing a few cases, then realize how much better everything runs.
Our structure also allows physicians to invest at fair market value, so they become owners with a real stake in the center. They get access to better payer contracts, and patients appreciate the streamlined experience. Everyone wants the same thing: good outcomes, efficient operations and satisfied patients. As we’ve grown, word of mouth has spread, and doctors now seek us out. Our biggest challenge is often just getting the facility built and certified.
Another key difference is that we integrate a clinic alongside the ASC whenever possible. That continuity of care – from the first visit to workup, procedure and follow-up – lets us collect robust data. It’s hard to get that data in a hospital, where the patient shows up for surgery and then returns to the surgeon’s office for follow-up. By integrating everything, we can truly measure our outcomes and keep improving for our patients, our doctors, and our payer partners.
Any other plans you can share?
We plan to expand at a very fast rate. Scaling is much harder than operating a single center, but our COO, Karen Reiter has been with me for almost 30 years. She’s developed the “cookbook” – the protocols and procedures for nursing, post-op care and more – so we can replicate our success across multiple centers.
