Here are some enlightening questions from readers over the past couple of months that others might find helpful:

Question: Pain management. You mentioned a couple of months ago in your article about an opportunity with pain management procedures in the OR. Can you share that in more detail? I spoke with a couple of pain physicians in our area, and they said they did not have an interest in doing procedures at our hospital. What’s the deal?

Answer: The operative word here is “hospital.” The reason many pain management practices wish to do procedures in a freestanding ASC is because they might have a partnership with or have a future opportunity to partner with the surgery center and, therefore, have a secondary income stream from the ownership in that facility. Their opportunity to generate that income would be based only upon their ownership interest in the center, however, so many of these physicians would rather develop and own the surgery centers on their own.

Question: Policy and procedure (P&P) responsibility. You spoke at a lecture I attended last year where you stressed the importance of staff understanding the facility policies and procedures as many of those have changed over the years, even months! What is the easiest way to make this happen? I have over 60 people in my department, and I bet half of them have no idea of the changes we make routinely to our P&Ps.

Answer: I did a “mock” survey for a new facility last week, and I asked one of the staff members the procedure for transporting a patient to a hospital for an emergency. He made up a bunch of stuff, but it was clear he did not know the procedure, and as a result, the facility was marked with a deficiency.

The best way is to give all employees the opportunity to read the policies and procedures and then have them sign a dated letter (which goes into their personnel files) that states that they have read and understand all the P&Ps. Often, signing their names to a letter helps convey a sense of importance and responsibility to it. As policies are amended, provide staff members with a “redlined” version so they can read the changes and sign on an inservice sheet that they have done so.

Question: Supply cost for cataract surgery. I was working in a local for-profit surgery center in town and wanted to get back into the hospital for more challenging cases. I was floored when I saw that one of the surgeons at the surgery center I worked at had supply cost of over $800 for his cataract cases that he did at the hospital. What got me was that at the surgery center, it was only $350! I know because I did his cases.

Answer: It is not at all uncommon for supply costs to vary greatly from a for-profit facility, such as an ambulatory surgery center (ASC), and a not-for-profit hospital. Some of the reasons include:

  1. ASCs typically pay less for the same item, even by the same vendor, because they often negotiate each item.
  2. Surgeons are motivated to conserve supplies in an ASC because they know someone is watching those expenses and it will increase the profits of the ASC that they might pocket.
  3. The surgeon might not know what the supply cost is in a hospital because often the staff members in the operating room don’t know themselves. She/he may assume it is the same as the ASC where they also work.

You might suggest your findings to the appropriate person at the hospital and recommend they make the surgeon aware of the costs variance.

By the way, the steps above are exactly what happens when people focus on cost control and ways to improve it! [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates, 114 Balcones Woods Drive, Suite 307-203, Austin, TX. 78759. Phone: (512) 297-7575. E-mail: Web:]