Same-Day Surgery Manager

Lessons learned with new ASC opening

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

We just opened our newest ambulatory surgery center (ASC) in Texas this week. We think it is our 206th, but we could be off on that number. While it is an ASC, there is some useful information for our hospital readers here. Please read on!

The center is a six-OR single-specialty center with an anticipated 8,000 cases in year one. We certainly will exceed that number in year two, as the total count for the physician investors current volume exceeds 15,000 cases in four area hospitals and two other surgery centers. There is no hospital investor. They were not invited by the docs.

While opening a new surgery center is not a big deal anymore, there are issues around this center that intrigued me. These issues offer lessons to other surgery centers, as well as surgeon offices and hospital outpatient departments, about how to achieve cost savings. Let's start with obvious:

• Equipment.

We will have spent a little over $2 million on equipment and instrumentation at this site. We came in under budget by about $200,000 because the surgeons (seven different practices) all agreed to a common set of major equipment systems and agreed to change their instrumentation needs, which is not an easy accomplishment, as many of you know. There was a lot of compromise, and a lot of vendors were upset, but the result was a huge savings for the ASC.

I always wonder, in these terrible economic days, why hospitals don't do the same. The money they could save by being firm on the systems they purchase and maintain would be enormous. Granted they would lose some surgeons that didn't get what they wanted, but they probably would lose them anyway if that is the way they function.

• Staffing.

We did not want to anger the local hospitals and other surgery centers (they might read this!) where the surgeons operate by cherry picking their staffs, but we had several applicants from those institutions anyway. Most of the applicants were from the hospitals.

Since Earnhart & Associates is managing this center for a long time, we were as picky as the surgeons about whom we hired. We wanted hungry staff! Of the 25 FTE positions we hired, only two or three came from the hospitals. The majority of the staff are new RNs and a few experienced scrub techs.

Most of the hospital staff members that applied did not want to be cross-trained (a requirement), wanted a full retirement plan year one (come on — it is a new center!), wanted the current salary they had at the hospitals where they had been for 15 years plus (and a bump even to that!), and they wanted facility-paid health insurance for entire family, not just the employee-paid. In other words, they wanted status quo and no risk. The surgeons gave us a clear understanding that they would much rather train new, energetic staff who were interested in growing their careers rather than staff that were at the end of their careers and had no interest in making the new center a success.

This information is a lesson to some: Often we have to take a chance when we are making change in employers. The new staff at the surgery center has no call, no emergency cases, no weekends, generally healthy patients, and no big hospital hassle. Often tradeoffs must occur!

• Physical building.

Due to size of the new center, we had to buy a building, tear it down, and start from scratch. Again, in these economically interesting times, you would think that cities would embrace a new tax source. Oh, no. They put up as many roadblocks as possible. Again, some people just do not get it. In spite of the city and the length of time it took to get permits, we still came in under budget on the building and opened two weeks early.

We were able to do our first case 12 days after our certificate of occupancy, which meant we beat our old record of 18 days. Thus, the city will get its revenue regardless.

• Vendors.

I know that I am usually hard on vendors in my column, but I have to hand it to these ladies and gentlemen: They really helped us obtain the best pricing, and they gave us outstanding service! I asked one of the reps why he was going out of his way to help us stay in our budget, and he told me it was because we were trying to be budget-conscious! That was cool.

• First patients.

Anesthesia cancelled our very first case. Medically necessary. A bummer for some, but I was delighted! We were setting the marker that patient safety was a huge issue for us.

Our second patient — well, really our first real patient — was 45 minutes late. Of course. That was even with the two pre-op calls and directions. He finally showed up, and his "responsible adult" took off as soon as the patient walked in the door. That was fun getting his ride home to come back to the center. The patient did, however, get into the operating room 4 minutes early (yes – I track that), had general anesthesia, and was discharged an hour later. So in spite of everything, the system still works.

Once again it proved to me why I love my job so much! Nice job by everyone.

[Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: Web: Twitter: @SurgeryInc.]