Our company works with 15 to 20 ASC clients per year. Most clients build their ASC from the ground up, but some have remodeled or expanded existing facilities. Ninety percent of our facilities are state-licensed and Medicare-certified. The rest are office-based ASCs or some type of ASC hybrid. There are some commonalities with our projects that might help others who are considering building a new facility or expanding an existing facility.

Assuming the owner has conducted a financial feasibility analysis and the numbers work, the following are important considerations when building a new center or remodeling/expanding an existing facility:

Design. Most ASC floorplans begin on a surgeon’s scratch pad. They morph into the finished product with help from outside consultants and qualified architects.

The Life Safety Code requirements for an ASC, at the state and federal levels of government, are not suggestions, they are mandates. Just because an architect friend designed a house does not qualify that person to build a surgery center.

Hire only an experienced architect who understands state regulations and CMS codes and who has built or remodeled many ASCs. The finished product does not have to win an award (although many architects will try, at the owner’s expense). Still, the finished facility must be able to sail through rigorous inspections.

Size of the ASC. Our experience shows hospitals overbuild, and independent surgeons underbuild ASCs. Never assume that if you build it, surgeons will fill it. Stick to the plan.

Mechanical, Electrical, and Plumbing (MEP). Typically, MEP planning is handled by a firm the qualified architect recommends. This firm determines the size and the location of the drainage from the selected sterilizer, to the placement of wiring.

Do not guess or put off these decisions. Construction cannot begin until this process is finished and approved.

Equipment. Selecting the equipment does not mean the surgeon knows what OR lights she wants or which surgical table. Surgeons may think, “We do not need an equipment planner; I know what we need.”

But this is one of the more frequent reasons some ASCs open late or have to settle for less than what owners wanted — waiting on backorders. Most consultants offer a room-by-room list of equipment needs. However, knowing what the center needs and purchasing it a fair price and receiving it on time are completely different.

Realistic expectations. It often takes longer than it should, but remember all the government agencies and private sector firms involved. Their schedules are beyond your control. A well-planned timeline will eliminate much of this stress.

As construction proceeds, the owner or others might consider changes along the way, such as:

Separate ASC lounge for surgeons. These are expensive and remove the ability of all staff to mingle and resolve any immediate issues that arise.

Salvation Army furniture. Do not make a bad first impression with patients by buying cheap furniture. It makes patients wonder if the center cut corners in other, more important areas.

Washer and dryer. Employees may not smell it, but others can when they visit. The requirements for this equipment are explicit. It is cheaper to send out linen for cleaning, or go disposable.

Hire for experience. Do not hire the nurse from the hospital who circulates cases to set up the surgery center. ASCs are big business, and they need highly specialized and experienced administrators and nurse managers.

Throughout the entire process, meet often with the hired team to review every aspect of the project. Do not assume everyone is doing what they should and when. The architect, project manager, and equipment planner should meet, at a minimum, of once a month.

Go to the work site as often as possible to watch what is happening. Question everything. If something remains unclear, conduct more research.

We love everything about surgery centers. The process of remodeling or building new ASCs is exciting and fulling for everyone. For most, it is a once-in-a-lifetime experience, so make it enjoyable.

A well-planned facility can produce decades of profits, happy patients, dedicated staff, and a sense of accomplishment and fulfillment. Enjoy the trip. 

(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Address: 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. Instagram: Earnhart.Associates.)