By Stephen W. Earnhart, MS


Earnhart & Associates

Austin, TX

We receive several dozen questions per month from individuals via our website, texts, phone calls, or email. Our staff can answer most questions easily. For example: “What does Medicare reimburse for a certain CPT code,” or, “What requirements does a certain state mandate for overnight stays?”

Fortunately, staff push some of the more interesting questions to me, which I enjoy. The more difficult the question, the more I like it. Over the years, I have shared (always anonymously, of course) some of my favorites. Here a few from the past month:

Question from a business office manager in a freestanding ASC: “We are struggling to find an effective way to communicate with our patients after they leave the facility. We have tried phone calls, text messages, emails, Pony Express — you name it. Any ideas?”

Answer: Since you are trying to reach them after surgery, someone in your center had the opportunity to ask the patient for the best contact information. If the patient offered the information but the patient doesn’t respond when you try to contact them, then leave the patient alone. We all experience privacy violations via robocalls, spam, and vendors. As important as we think we are, not everyone concurs. Many surgery patients see us as a place for some episodic event in their life and they don’t necessarily want continued dialogue with us. Respect it.

Question from a surgeon investor in ASC: “I am an investor in a surgery center. Our management company is selling shares to an equipment vendor, not another surgeon. I didn’t think that was legal, but I don’t want to bring it up if I am wrong.”

Answer: It is not “illegal,” but there are two issues here. First, check your partnership agreement. Typically, when any partner in an ASC sells all or part of his or her shares, the person they sell it to has to be approved by the other members first. Also, those existing members usually have the “right of first refusal” to purchase those shares for sale.

Second, anytime non-surgeons purchase ASC ownership (i.e., anesthesia, management companies, or others who do not actually perform procedures in the facility), it can raise red flags with the “safe harbor” issues (which are too detailed to explain here). Check your partnership agreement, and ask your management company about any safe harbor issues.

Question from an RN who works in a hospital and moonlights in an ASC: “Our hospital has an electronic medical records (EMR) system that is not very good, but the surgery center I work part-time in doesn’t have anything. Everything is paper and logged on Excel spreadsheets. As bad as the hospital system is, it is certainly better than the surgery center that has nothing. My boss at the hospital told me that the surgery center I work at is required by Medicare to implement this system and that what they are doing is against the rules of Medicare. I don’t want to leave the job at the ASC because it is a fun place to work and I need the extra money, but I don’t want to jeopardize my license by doing so.”

Answer: Keep your part-time job. Medicare (CMS) does not require licensed ASCs to maintain an EMR (not yet, anyway). It is coming, and many freestanding surgery centers already put an EMR in place for the same reason you cited: It is better than paper. However, Medicare does have very specific regulations on documentation of data, which CMS monitors. Chances are that the surgery center you are working in is in compliance.

If you would like to ask questions, please feel free to send them.

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: