I asked several nurses over the past few months about what their greatest concerns were related to their positions in ASCs and hospitals. I was surprised by what I heard. Since I have been away from the clinical side of nursing for many years, I could not relate to all comments.

Their number one fear is making a mistake that could cause harm to a patient. “First, Do No Harm” is something I remember from nursing school and, apparently, it has affected us all. Many worry about administering the wrong medication or dosage. These fears are justified.

Fortunately, manufacturers are making clearer labels to help prevent these errors. Regulators from the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, The Joint Commission, and Medicare are strongly enforcing the proper labeling of syringes in the surgical environment. As a Medicare surveyor, I give more deficiencies for improper labeling than anything else. It is a concern to all of us and our patients.

Several commented on “minimally invasive management” vs. “in-your-face” management by some companies for your facilities. As the complexity and liability on oversight of surgical services intensifies, so do the risks. Many independent surgery centers shun corporate “meddling” in the day-to-day operations of their hard-earned pearl. Administrators are turned off by the high fees associated with such, but still want an outside “third party” to keep them compliant. This is a daunting task since rules and regulations change constantly. Those who cheered the loudest were the nurse managers and administrators who like to run their own shop but value outside advice on issues and comfort in complying with regulations.

Celebrating people. Many facilities are bringing back staff-related functions like “Wind Down Fridays,” birthdays celebrations, and “Making Our Numbers” festivities. It is great to see medical professionals celebrating accomplishments and each other.

I received several questions about whether it is appropriate to serve alcohol at such events. Many of our new ASC board meetings with clients involve wine after the event, but these events take place offsite and involve small groups. Many staff parties furnish “near beer” or non-alcoholic drinks — same taste, but without the lawsuits.

Site-neutral payment policy. CMS plans to continue their site-neutral payment policy under Section 603 of the Bipartisan Budget Act of 2015. If this proposed rule takes effect, as it looks like it will, an off-campus hospital outpatient department for surgical services will only be paid 40% of the Outpatient Prospective Payment System amount for 2019. This means we may see many more surgery centers, as the payment differential between ASCs and hospitals continues to neutralize. Medicare is growing weary of paying more for the same procedure when it is performed in a hospital vs. an ASC.

Freestanding emergency rooms. Another trend to watch at your facility: If your freestanding ASC suddenly starts developing a freestanding emergency room in the same building, you might be in for a pleasant surprise soon. Several of our clients are doing just that as the climate for more physician-owned hospitals resurface.

(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.)