Sell to ASCs and Office Labs Before Hospitals?

Often, yes, if your product fits the procedures done there. Ambulatory surgery centers and office-based labs avoid a lot of the friction and inertia you hit in a hospital. They still have governance, but the decision is closer to the physician, and that makes a big difference when your runway is short.

Why are outpatient sites faster to get into?

Start with what happens in hospitals. Getting a new technology through a value analysis committee and into the hospital's routine can take forever. The committees have changed, too. Doctors don't even sit on about half of them anymore. Your champion often isn't in the room when the vote happens.

In a surgery center or an office-based lab, the physician is the gatekeeper. If you have the right two or three doctors aligned in the center, you will probably get through. And if the physician owns the center and really likes the product, it is probably going to happen.

In a hospital, plan for a committee process that can run for many months before the first order. That is runway many startups don't have.

Speed matters because most startups don't have time to burn cash. I would rather go to a surgery center where accounts turn quickly than wait a year and a half to get onto a large health system's contract.

Do ASCs still run value analysis?

Yes. Everything has governance, and surgery centers review new products too. The difference is that the process is less of a black hole. There are fewer decision makers, and your relationships mean more when a doctor is the chairman of the board. Don't walk in assuming there is no process. Walk in knowing it is shorter and that the physician's opinion carries real weight.

How big is the outpatient opportunity?

In my space it is large and growing. When I looked at the data recently, about 67% of all peripheral endovascular interventions were being done outside the hospital. Not long ago it was the other way around.

Not everyone sees that shift the same way. One person I spoke with pointed out that total spending hasn't gone down as care moved out of the hospital, because volume went up. That is worth knowing, because payers and policy can change how these sites buy. But for a startup choosing where to sell first, the volume is moving to where the physician has more say.

When should I still go to the hospital first?

If your procedure isn't done in outpatient settings, you don't have a choice. Hospitals it is, and you should plan for a long committee process from day one.

Even if you do start outpatient, don't ignore the hospital path. One strategy I like is to start with the group purchasing organizations. Each one has a pathway for breakthrough technology. If you can get on it, you have that stamp of approval in hand when you go to a hospital committee. Founders often resist working with a GPO because of the fee. But when you have zero revenue today, you are not giving anything away yet. You are building a red carpet into the hospital.

Where should I start?

• List every surgery center and office-based lab in your target markets that does your procedure.
• Find out which ones are physician-owned and who the decision makers are.
• Build relationships with two or three physicians per site, not just one.
• Capture the results from those accounts so they become proof for hospitals later. Real cases and physicians who can speak to the product carry weight in any committee.
• Start the GPO and hospital process in parallel, because it takes the longest.