Questions from trenches of outpatient surgery
By Stephen W. Earnhart, MS
Earnhart & Associates
I’ve received a lot of emails with questions through the Same-Day Surgery newsletter each month. Thought I would share some with you.
Question: Our docs are getting a valuation of our surgery center. It is making everyone nervous that they are going to sell this place. When we ask them, they say they are not selling, but why would they do a valuation if they are not? Seems weird to us.
Answer: Well, they could be selling, but there are also many other valid reasons for getting a valuation of a business that don’t necessarily involve selling it. It could be they are taking out a loan for an expansion. Could be a new investor coming in. Sometimes in a divorce, the attorneys want an update of a spouse’s net worth. Could be they just want to know what their investment is worth. Don’t get too paranoid until you see me walking around the center!
Question: Our drug and equipment and disposable reps used to really treat us with food, gifts, events, etc. They don’t do that anymore. Have you heard from others the same thing?
Answer: Yes. They, the representatives from a number of companies, are not giving anything of value to their clients. The "Sunshine Act" requires manufacturers to report certain payments and gifts given to physicians and teaching hospitals. I am surprised it is just now happening to you. They are no longer the purveyors of cool stuff anymore. I hate it!
Question: I heard you speak last month about ACOs [accountable care organizations] and their effect on surgery. Bottom line: What is their end game?
Answer: They want three things right up front: one, lower cost for surgery; two, better outcomes that you can prove; three, less surgery -- period! Bottom line.
Question: Can our surgery center pay for our CEUs classes we take to keep our license as RNs? Our medical director told us that it was against the law for them to pay for them as it would make them liable for anything we did that we learned at the course. Is that true, or are they just cheap?
Answer: They are just cheap. I have never heard of that, nor has anyone I have spoken to about this heard of it.
Question: Our surgeons want to start keeping our plastic surgery patients in our surgery center overnight in the recovery room. They cannot do that, right?
Answer: As long as the patients don’t stay longer than 23 hours and 59 minutes from the time they are admitted to the facility it is OK, but you need to check your state laws as some states are different.
Question: I have worked in a hospital for years and just started working at this surgery center, and I am shocked that the surgeons here do not accept Medicaid patients. They are required by law to accept these patients, and I am going to let them know. I think this is terrible!
Answer: Most surgery centers are private businesses, and they are not required to take Medicaid patients, even if they accept Medicare patients. The requirements for not-for-profit hospitals are different than your new employers. Better rethink your conversation.
Question: Our hospital just lost a very busy spine surgeon to a surgery center. The surgeon is taking all the high-paying spine cases to that surgery center, but he brings us the Medicare patients, which is a much lower reimbursement than other payers. Have you seen this before, or is this guy just skimming the highest reimbursable payers?
Answer: Before you get more upset, you need to know that most spinal surgery cases for Medicare patients are not allowed to be performed in an ambulatory surgery center. Not only will they not get paid for the case, but they cannot even do the cases there. If a procedure is not on the Medicare list of approved procedures that can be done in an ambulatory surgery center, they cannot be done there.
Question: Is there a minimum square footage that a surgery center can be in order to be licensed? My surgeon wants to start doing his cases in space we have in our office.
Answer: The requirements for a Medicare-approved ambulatory surgery center are very stringent regarding the space that they will certify. But in answer to your question, the minimum necessary for a one-OR surgery center that is licensed and Medicare approved would be about 4,500 square feet. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates’ address is 5114 Balcones Woods Drive, Suite 307-203, Austin, TX. 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. E-mail: firstname.lastname@example.org. Web: www.earnhart.com.]