Image by Leszek Stępień from PixabayTrauma surgeon Ronen Elefant is flying surgeons into rural hospitals and outpatient clinics, inspired by his own experiences in health care.
ACES, short for Aviation-Commuting Employment Solutions, is a startup that aims to help rural hospitals and smaller towns that struggle to recruit surgeons.
“The problem that it solves is bringing top-notch surgeons to rural areas that otherwise would not get the best of the best,” Elefant told ASC News. “Most surgeons who are at the top of their field want to be in a major academic center.”
The concept isn’t entirely new. Locum tenens, or “locums,” refers to physicians who take temporary assignments at hospitals or clinics to fill staffing gaps, usually arranged through an agency.
Elefant, who is the trauma medical director at UPMC Williamsport in Pennsylvania, got his start doing locums work.
“Even though I had a full-time job out of fellowship, I had extra time to do locums work, and I was doing it in many underserved areas or just in places that were difficult to staff with people who would live in the area,” he said.
Elefant said ACES is still in its early stages, focused mainly on recruiting surgeons and facilities. ACES is registered in Florida and based out of Connecticut, currently working with two physicians, though Elefant said he has many more who are interested.
The combination of staffing and aviation logistics can change the market, he said.
The model works like this: ACES contracts directly with hospitals, bypassing the cut taken by locums agencies.
“I think they would get paid better than locums because we cut out the middleman,” Elefant said.
Elefant said private aviation is what makes the model stand apart.
“If you tell a surgeon, we’re going to pick you up from an airport a half hour or 45 minutes from your home, and drop you off about 15 minutes from the hospital on a private aircraft, you’re traveling with other surgeons, networking,” he said. “You know, it’s a completely different lifestyle. It really takes a lot of the pain points of traveling for work and flips it on its head.”
For now, ACES is focused on building out its surgeon and facility base, but Elefant has clear goals for expansion.
“Initially, I think it makes more sense to target specific geographies, like maybe something in the Northeast or the East Coast, and then expand moving to the Midwest,” he said. “I know that there’s a need on the West Coast, especially because geographically there’s a lot of health deserts. The facilities are farther apart, and the aviation model for that geographically makes more sense.”
A rotation system could be one way to scale, he said.
“Let’s say you put in the constraints of, OK, they can be up to an hour drive to the local airport, where we would do like a group pickup of four to five surgeons, transport them to this hospital for a week, come back a week later, swap them out,” he said. “Potentially you have a rotation at every one of these hospitals, and then you just have a plane drop-off a team, pick-up a team.”
Elefant said he sees potential in the ambulatory surgery center (ASC) space, and ACES may move faster there than in hospitals.
But ACES outpatient may not involve aviation right away. Instead, his idea is to partner with existing centers and run a direct-pay model.
“What I quickly realized is that there’s 9,000 ASCs across the U.S., and it can’t be that they’re all at capacity,” he said. “So rather than treating it as a hardware problem where we need to build another ASC, let’s treat it as a software problem. The infrastructure exists. Let’s partner with ASCs that are not at capacity and negotiate with them for facility fees and anesthesia fees.”
That work is already underway.
“I have an ASC in Charleston that we agreed on the prices where we’re signing contracts now,” he said. Basically, the next step is to source the patients, which is mostly through self-insured brokers and DPCs, so that could be up and running potentially as early as the New Year.”
Procedures would focus on common ASC-friendly cases, he added.
“The initial specialties that I have going are general surgery, so gallbladders, hernias, lumps and bumps, chemoports, abscesses,” Elefant said. “Orthopedics would be mostly scopes and anything that can be done orthopedically as a same day surgery.”
Underpinning the model is the belief that outpatient care is the future, Elefant said.
“It’s so inefficient to do things in the hospital, both in terms of time and cost,” he said. “If we can do the same surgeries at an outpatient center, which can do a lot more volume in the same amount of time, it’s much more cost effective.”
And for patients, the difference is tangible.
“I think the patients feel like they’re getting more of a white glove service when they go to an outpatient center to get their surgery,” he said.
