By Stephen W. Earnhart, MS
Earnhart & Associates
One of the most requested columns I do is take real-time questions from staff members in hospitals and ASC facilities and put my responses to them here – for all to read. I get many so many emails after each time I do this from readers who say, “That is exactly what we are going through!” or, “We have the same questions!” That encourages me to do more! As always, feel free to email me any questions you have – if it has wide appeal, I will add it to the list to share with others. And, as always, your questions are 100% confidential!
Question from RN in freestanding ASC: “I was just hired to run a new start up surgery center. I was surprised to hear that the ASC, while licensed as such in Texas, is not going to be Medicare Certified. The facility I came from required Medicare certification. Did I make a mistake by changing to a surgery center that is not certified? Will it hurt my license?”
Answer: Medicare Certification (CMS) is not required to do surgery in Texas (or any other state). You can do surgery without the expense and oversight of CMS with just a state license, much of which has the same requirements of CMS. However, you cannot treat federal patients, Medicare, Medicaid, CHAMPUS (Civilian Health and Medical Programs for Uniformed Services), and others without it. Also, some insurance payors will not contract with you if you do not go that route. Some surgery patients, such as ophthalmic patients have a high payor mix of Medicare patients and they require certification. Others, such as plastic procedures, have a very little Medicare population and they do not feel taking the next step is necessary.”
Question from Hospital Surgical Department Head in South Carolina: “We have been competing for staff in our small town against a very successful freestanding surgery center that our orthopedic group established several years ago. Our greatest obstacle in attracting staff back to the hospital is the profit sharing that the competing facility offers. As a not-for-profit hospital system, we cannot offer profit sharing like these ‘profit mills.’ It is an unfair advantage.”
Answer: Well, without getting too political, remember that as a not-for-profit organization, you do not pay taxes on your revenue and the ASC does. Your competitor could say the same about you having an unfair advantage. BUT! You can offer non-financial incentives to your staff as well. There are many more qualified authorities, who could offer examples, than I, but here’s one of my examples: hospitals can provide an incentive to staff to reduce start time delays and room turn-over time by sending them home – with pay – when their room cases are complete. Paid time off is a huge advantage to staff. The process is too complex to get into here, but you can figure out the details.
Question from RN in physician practice that has a surgery center in same building: “We are a pain management practice that is building a surgery center across the hall from our practice. Most of the staff of the practice will eventually work in the surgery center when we are not working on the practice side. Our doctor says that we will have to ‘clock out’ of the practice side and ‘clock into’ the surgery center when we work at either one. This sounds like a way to avoid paying overtime!”
Answer: From a licensing and Medicare standpoint, your pain management practice you’re your surgery center, although across the hall, are two totally different businesses that require separate booking, staffing, etc. Compare it to working in one hospital and moonlighting in another. You have to follow the same protocols.”
Question from a medical director in a freestanding surgery center: “I just became the medical director in this new surgery center. I am not used to this! I was a very busy anesthesiologist for a large hospital and I took this job to slow down and take it easy. I am shocked by the furor of activity in this place. The staff does not take breaks and works through lunch. The surgeon wheels their patients into the operating room and actually help turn over the cases. One day the nurses will work in PACU and the next day circulate the rooms. I had no ideal of the intensity of activity and was not anticipating this when I took this job. They do more cases by noon than we did at the hospital by 6 pm. I truly see the attraction to independent surgeons. Wow!”
Answer: One thing most hospitals do not understand is that, for the most part, freestanding surgery centers are established for time efficiency – not profit. However, that efficiency does generate profit if done properly. Non-employed surgeons only get paid when they do surgery. The time they wait for their patient to be taken into the room or wait for the room to be turned over between cases, is down time for them that they do not get paid – unlike the hospital staff. Inefficient utilization of time hurts everyone.”
[Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979.