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Mike Cote's Business Editor's Notebook: Booming Bedford surgical center had few champions at first

April 07. 2018 5:56PM
Nick Vailas gives a tour of the imaging center at Bedford Ambulatory Surgical Center in Bedford, which he oversees. (DAVID LANE/UNION LEADER)

Nick Vailas walks across the parking lot at Bedford Ambulatory Surgical Center when something shiny catches his eye - a dime on the ground with its head facing up. Vailas excuses himself and picks it up.

"You can take me out of Grove Street, but you can't take the Grove Street out of me," says Vailas, who grew up near Gill Stadium in Manchester.

That shiny dime brings back a flood of memories.

"Every night after football games, we used to go under the grandstands, and in those days there would be 8,000 to 10,000 people. People are cheering, and the change would fall out of their pockets. You'd maybe be able to get an ice cream later."

Vailas remembers scraping up enough change to buy some ice cream. He doesn't think people should have to scrape up their last dime to pay for health care. For the past 25 years, Vailas and an ownership team of physicians have been operating an independent outpatient surgical center that aims to drive down costs.

Vailas and six doctors, including his brother, Jim, an orthopedic surgeon, founded Bedford Ambulatory Surgical Center (BASC) in April 1993. It was a small partnership by necessity, not by choice.

"We had gone to 48 surgeons to do a proof of concept. Only six of the 48 agreed to go forward, and no one thought we were going to succeed," remembers Vailas, an exercise physiologist who previously owned rehabilitation centers. "It was iffy the first year."

BASC initially focused on orthopedics and plastic surgery, but over the years it has expanded to provide ear, nose and throat treatment, gastroenterology, urology, podiatry and diagnostic imaging. Its most recent addition is the BASC Eye Institute, which offers cataract and retina surgery.

Nick Vailas poses for a photograph at Bedford Ambulatory Surgical Center in Bedford, which he oversees. (DAVID LANE/UNION LEADER)

Same-day service

"What we're doing now is a significant amount of total joint replacements," says Vailas, president and CEO of BASC. "Because of the advancements in pharmacology, technique in anethesiology, technique in orthopedics, composites, we're able to replace your joints - hip and knees - in one day. Most of those patients are going home the same day."

The initial skepticism long gone, BASC currently has 32 physician partners. In 2000, Catholic Medical Center bought a 50 percent stake.

"They've been a great partner," Vailas says.

Two of the original six surgeon partners have died, and two have retired. That leaves the Vailas brothers and Dr. Steve Brown as the only remaining original investors. Brown, a plastic surgeon who also performs hand surgery, said the ability to work independently was the initial draw.

"It's been a wonderful financial thing in the long term, but in the short term it was really just to be able to have our own say with regards to how the OR was going to be run and what equipment you would have and how we could run the schedule," Brown says between surgeries in a BASC break room.

Some his colleagues thought he was making a bad decision.

"A lot of docs at the hospital laughed at us. They thought there's no way it's going to succeed," Brown says. "I think they didn't have the foresight to realize there was the potential. I don't think we ever thought it was going to be as big as it is now either."

Hospital alternative

The medical park at Washington Place in Bedford that is home to BASC was a much quieter spot in 1993.

"There was really only one building down here in this medical park," Vailas says. "Basically it's evolved into a patient friendly environment where you have focused centers of excellence."

He touts BASC's role as an alternative to care provided in a hospital setting.

"For example, here is the surgical center. Next door is physical therapy," Vailas says during a walking touring of the grounds. "You've got the doctor's office. Across the parking lot you have imaging. So patients can literally drive right up front to the service they're getting. They're not walking down miles of corridors, through massive parking garages. So it's a better patient experience, but most importantly, it's at a far lower price point."

The era of health insurance plans with $5,000 deductibles has elevated the prominence of outpatient providers like BASC, which charges hundreds if not thousands less for colonoscopies, for example, than some hospital-based providers. That prompts businesses to encourage their employees to seek the lowest cost service; some offer their people cash rewards as a carrot.

"Our mission has always been basically twofold: to bring better value to patients, improve their patient experience, improve the price point - that's value," Vailas says. "The definition of value in health care is, does the patient perceive satisfaction over its price? Price has been nebulous. There has never been a lot of information on price, but now because of high deductibles, people are concerned about what they are paying."

Vailas also oversees ExpressMED, which operates three urgent care clinics in Manchester and Salem. Its sister company, Member Medical, offers a $10 per person per month membership that includes five urgent care visits a year for flu symptoms and other everyday illnesses for a $10 visit fee. It offers discounted fees for other medical services, including diagnostic tests. Vailas also is developing a Member Medical insurance plan.

"What can't get lost is we are on a mission to keep health care reasonably affordable," Vailas says, "because the price of health care is the leading obstacle to access."

Contact Business Editor Mike Cote at 206-7724 or

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