First, I want to thank the readers for the many emails you sent regarding negotiation tactics that appeared in the May issue. It seems plenty of readers found those tips helpful — not just for your surgical department, but life in general. Thank you all for your kind words.

Every year, I like writing a column in which I answer reader questions. It is an opportunity to interact with many readers and to help with important issues. Here is a sample of some recent reader questions I have received:

Question: “We have been approached by a group of cardiologists to perform some procedures for them at our ASC. We are meeting with them next week and wanted to know what we can do in our center with them.”

Answer: Cardiology is going to be the next big opportunity in non-hospital surgery centers. There are pacemaker implants, electronic leads, changing pacemakers, replacing batteries, replacing stents, and several other procedures you can perform in an ASC. Reimbursement is high — but then again, so are the costs of the devices. Do your homework on costs before jumping into it.

Question: “Our surgery center’s growth is hampered by the anesthesia group. We are a relatively new ASC with four “Class C” operating rooms. We are ready to work, but the group selected by the doctors will only let us open one or two rooms per day. They also make us cluster the cases together so they can be ‘efficient’ in the use of their staff. Apparently, they do not have enough staff to cover all the rooms. They told our surgeons that they could recruit new CRNAs, but the doctors would have to pay the group a stipend to cover that cost. I sure hope no one else has to deal with this because it is infuriating all of us.”

Answer: Surprisingly, you are not alone. This is a known issue, not only in ASCs but in hospitals, too. First, the Centers for Medicare & Medicaid Services (CMS) requires that you enter into a performance-based contract with an anesthesia provider. You may enter into as many of those contracts as you want. We once worked with a facility that partnered with 15 different anesthesia providers, sort of a nightmare in pairing the surgeon with the anesthesia personnel, but it worked for them. Unless you have an exclusive contract with your anesthesia group, bring in another group or individuals to cover the rooms your current group cannot. If you are locked in an exclusive agreement, let the group know they are not providing services based on your initial criteria for coverage. You cannot be held hostage to restricting the surgeons’ investment and all the efforts that went into your facility because anesthesia cannot or will not expand their services. It is kind of like going to a restaurant with empty tables but the wait time to be seated is long because the restaurant does not want to hire more waiters.

Question: “What do you see as the best type of cases to handle in a surgery center?”

Answer: By “best,” I assume you mean the most profitable. You can make money on just about any procedures you perform in an ASC. It depends on the number of those cases and your ability to cost your overhead.

If I was running a surgery center today, I would focus on total joints (hips, knees, shoulders), cardiology via a hybrid surgery center with a cath lab and ASC, bundling everything, and spine. There is nothing wrong with other specialties, but you asked.

Question: “What is the most inexpensive way to expand your facility?”

Answer: Add a Saturday schedule and one or two evenings per week. It is absolutely the least expensive way to expand. n

(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: Instagram: