Same-Day Surgery Manager

Inpatient vs. outpatient: tough questions addressed

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

I have received so many phone calls and e-mails about the September column on the separation of inpatient and outpatient ORs that I thought a follow-up to some of your questions was necessary. Overall, the response was very favorable and positive.

Question: What do you do about patient registration when inpatient and outpatient ORs are separated?

Answer: The patients are registered via the "surgery center" staff on site and not incorporated into the inpatient registration process.

Question: If you are using a traditional surgery center management information system (MIS) to track your productivity, how are you generating the hospital-required admission or medical record number?

Answer: Admittedly, this proved to be a huge issue that confounded our transition team for a while. We were able, working with the software designer, to add a new field into the software that would allow us to generate or mimic the hospital medical record number. The other issue that we faced was sharing the demographic information that the hospital has on file and to be recognized in the hospital system. For that, we had to write an interface that served as a go-between in terms of the two software programs. It was not easy or cheap, but it was effective.

Question: Who does the billing for the hospital outpatient department surgery?

Answer: The hospital. We essentially "outsource" the billing to the current hospital department.

Question: Who do staff members at the center report to?

Answer: The staff reports to the outside management company that was hired by the hospital with input from the physician advisory board (PAB). While the director of the department is an employee of the management company, the rest of the staff members are employed by the hospital but dedicated to the outpatient surgery center.

Question: I assume that the existing anesthesia department of the hospital provides anesthesia services.

Answer: In some cases, yes; in some, no. We rely heavily on the input from the PAB on this issue, which can be heated at times.

Question: With some many surgeons involved in for-profit surgery centers, why do they want this model? They get nothing out of it as I can see.

Answer: While the surgeons do not have an equity position, they do have what most surgeons are looking for in a freestanding center: time efficiency. That is one of the primary motivators for the program.

Question: What if the surgeons decide that they want to do their own center? It seems to me that after all this effort, they could still take their cases someplace else.

Answer: Completely true. The goal, however, is to provide them everything they are looking for right in the hospital. For those surgeons who feel they must have their own center, this might not meet their needs.

Question: How can you motivate staff that is hospital-based and needs to be treated like any other hospital staff? You cannot financially motivate one group of employees different than another. This is where your concept falls apart and will not be successful.

Answer: First, we assume that professionals are self motivated. Second, each staff member is hand picked by the management company and the PAB. We are looking for those staff members who are motivated to make it happen. At our most recent facility, we had more than 300 applications, and only about 20% came from the hospital. Motivation is not financially based for most professionals.

(Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 1000 Westbank Drive, Suite 5B, Austin, TX 78746. E-mail: Web: