By Stephen W. Earnhart, RN, CRNA, MA

CEO, Earnhart & Associates, Austin, TX

Due to your busy schedule, the following are some questions you may not have considered:

• Do you know what SRS means? The demand for sex reassignment surgery (SRS) is rising. I believe we may be creating one of the first freestanding surgery centers dedicated to SRS in the Midwest. When we were approached by the surgeon to develop the facility for them, I was surprised and honestly not aware of how many procedures are involved in SRS. The facility layout is different from most, the fees are high, and the publicity and advertising is minimal. Word of mouth is the form of advertising for the services among those seeking the procedures. The surgeons involved in the procedures are typically plastic surgeons, urologists, and gynecologists. You might want to ask any of these specialists at your hospital or surgery center if they are interested in setting up one of these unique surgery facilities.

• Two licensed surgery centers in one? Dual-licensed surgery centers, recently approved by Medicare and some states, are the hottest item on our clients’ to-do lists. The ability to operate a licensed and Medicare-approved surgery center sharing the same location has been overdue — say farewell to OR leasing. These facilities are so attractive because of the ability to have different payer contracts from each of the entities. An “in-network” facility and an “out-of-network” facility can exist together conveniently in one ASC. Naturally, there are many moving parts to this process (and some restrictions), but, overall, these dual-licensed facilities can save millions of dollars in building, equipment, staff, and paperwork costs. We know many surgeons who would like to bill a procedure “out of network” for some, but “in network” for others. This satisfies that desire. Investigate further, especially state laws, to see if you qualify.

• Hospital reimbursement and surgeon investment in a hospital outpatient department facility? Yes, you can. There are restrictions, but if you meet the requirements, you can have your cake and eat it, too.

I will admit this was a first for us, and it took a great deal of research on our part before we understood and accepted the project, but it is possible. The surgeon’s shares were purchased 100% in the first day of the offering. This may be an option for you if your hospital community qualifies.

• Total joints in an ASC? Total joint replacement procedures performed in an ASC is not for every facility. With Medicare on the brink of releasing the dogs systemwide on this, many existing ASCs are disappointed in the requirements needed to offer this service.

We have met with many surgeons excited about offering this service only to realize that they cannot perform these cases in their surgery centers.

Before you get too excited about offering to your patients, you need to understand the physical requirements of your surgery center. Be sure to investigate exhaustively.

• Minimally invasive management? Minimally invasive hospital and surgery center management is available to facilities that cannot or do not wish to spend big bucks for full service management services. There are firms that offer this comprehensive service for a fraction of the cost. Be sure to research the alternatives.

(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: searnhart@earnhart.com. Web: www.earnhart.com.)