In 2006, the Surgery Center of Reno, a joint venture with St. Mary's Hospital in Reno, Nev., was performing 500 cases a month — and losing money. A little over a year later, after it partnered with our ASC management company and recruited 22 new physicians, we turned a -15% return on investment to a 110% return on investment. How'd we do it? In addition to a shift in management structure, from majority hospital ownership to majority physician ownership with business operations run by our corporate partner, one major key to our success was the addition of spinal surgery to our facility's case mix. Today, about 25% of our facility's profits come from spinal procedures, which make up only 4% of the cases we do.