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

I have worked in the surgery industry for four decades and during that time, I have noticed things that perhaps others have not. The following are some of my observations, with which you may or may not agree.

  1. Your facility is overstaffed by at least 10%. Hospitals have a better way to shield this fact due to emergency cases, involved cases that run over, and poor personnel management. ASCs just tend to get away with it because no one is actually looking.
  2. Your inventory is way too large. Most facilities have overstocked inventory because their vendors need to dump supplies to make their quota and bonuses, staff doesn’t want surgeons mad at them if they don’t have exactly what they want, and no one is actually looking at it because they don’t know how to gauge it.
  3. Most of your staff is insensitive to patient needs, and rude when questioned by patients. Don’t believe it? Sit in your waiting room for 30 minutes and observe.
  4. Most of your professional staff is underpaid. Compare what your nurses do to the duties and pay of others outside. The poor wages mostly are due to incompetent administration that cannot see beyond the numbers.
  5. Your waiting rooms are third-world environments. This is the first exposure your patients and families see when they enter your facility. You are setting up for a bad patient experience right from the start.
  6. Anesthesia will not help you in cost control. They have no incentive.
  7. If you charge your patients to park while they use your facility, you are cheap and gouging them. Would you go to Starbucks to get a latte if you had to pay to park to get it?
  8. Surgeons make no money between room turnover or waiting for delayed cases. This is the biggest reason there are 6,200 alternatives for them instead of you.
  9. Most “pre-op” testing is revenue-based and not in the patients’ interest or for their protection.
  10. Hospitals offer no time incentives for their staff to turn over rooms quickly and start cases on time. Sending staff home with pay when their rooms are finished is a start.
  11. Requiring patients to come to your facility two hours before surgery is ridiculous. This just highlights your inefficiency.
  12. Only 30% of facilities have updated policies and procedures. Why? Because the odds are that you will get away with it.
  13. Eighty percent of you do not capture all your patient charges.
  14. Ninety percent of you don’t even know it.
  15. Most ASC medical directors don’t know what is required of them.
  16. Elimination of the Affordable Care Act will have virtually no effect on your job.
  17. About 99% of facilities do not offer enough supply or equipment storage space. This problem results in cluttered hallways and sterile corridors that make you look “trashy” to patients wheeled into the operating or recovery room. Second impressions also are negative.
  18. Most surgeons don’t care about your personal issues. Save them for Facebook.
  19. All staff resent surgeons talking about their new homes or cars or boats, while they struggle with day care costs and day-to-day expenses. A good surgeon is a quiet surgeon.

(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. Email: Web: