Cooler temperatures, kids back in school, and renewed energy mean a change in season. As the seasons change, it is a good time get to the task of fixing a few issues at the office.

Here’s one: surgeons taking out some equity in their investments in ASCs. It is a common practice that surgeons want to sell off some of their interest in their surgery center investment. Fall seems to be the high season for that. It is a good thing, as we need new blood in our facilities to bring improvement ideas, different procedures, and generally plot a new course for the facility. Not all like change. It can be intimidating and create a false sense of insecurity. It should be just the opposite in our line of work. CMS continues pushing more complex and higher-paying procedures into surgery centers, forcing many of us to respond with updated equipment, physical renovations, new staff training, and higher revenue potential. Many facilities are incorporating complex spine procedures, total joint replacement, and cardiac cases into our rapidly expanding business model of freestanding facilities.

Conversely, many hospitals are tightening their belts and learning how to deal with the exodus of some of their prized money-making jewels. Is it any wonder that hospitals continue to develop their own ASCs, buy interest into existing centers, or buyout outpatient surgery centers? Is it any wonder that surgeons wanting to take some equity out of their investment are turning to these perceived deep-pocket hospitals as buyers?

Surgeon recruitment is becoming an industry of its own. I know of many facilities that are courting this new breed of surgeons who had no interest in partnering with a surgery center but now see others taking their formerly hospital-only procedures away and performing those procedures in an invested surgery center. If you are not actively hunting these new specialists and welcoming their procedures into your building, someone else will.

ASCs are paying handsomely to bring in these cases. Some, typically nurses or past employees of a surgery center or hospital, charge up to $10,000 for recruitment of a surgeon, plus a percentage of their contribution for up to a year after they bring their cases to the facility. You may say to yourself, “I would never pay someone to bring surgeons to my facility.” It is happening all across the country, and it is time to discuss this trend internally.

Explore your facility and ask yourself if you can accommodate more cases. Are your older surgeons slowing down and taking longer and more frequent time off? Is staff getting a little bored with performing the same procedures all the time? Fall is a good time to refocus and re-energize yourself and your center.

The leaves will be changing soon and you should, too.

(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: Website: