Same-Day Surgery Manager

Addressing fragmentation of surgical services

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

Inpatient surgery is on the fifth floor. L&D is on the third floor. The GI center is near the ED in the first floor. The outpatient surgery center is on two. The lithotripsy is in a trailer in the parking lot. The heart center is in the medical office building across the street. The spine center is down the hall. Whew! The oncology center is . . . somewhere. The breast center is to the right of the elevators, fourth floor, in the new pavilion, over near the duck pond, on Bleecker Street.

Be honest: How close am I?

Where are we going with this? Is it any wonder we are having health care reform shoved down our throats? Is it any wonder that anesthesia is throwing its arms in the air trying to figure out how to cover all these locations? Consider the plight of the poor patient who has to find an operating room location based upon body part. It is silly and is out of control.

How did we get so fragmented? I am a great proponent of separating inpatient from outpatient. They are completely different classes of patients with differing needs and outcome expectations, and the facility and staff need to respond accordingly. The others? I think this industry needs some better architects and stronger, more intelligent thinking in the space planning department.

Ever live in a cheap apartment? I mean the kind where you can hear your neighbor using the bathroom? I have. Know why? Those buildings are built with "straight-line" plumbing to cut costs. All the bathrooms, kitchens, etc., are on one vertical line. We don't have to be that cheap, but it wouldn't hurt to lean a little closer to it than we are.

Most hospitals have a "strategic planning department." Ask to be a part of that group. They won't like it and will resent you and laugh behind your back — but hey, why not? So many times, new facilities are erected with little or no input from the staff. Get involved in your own hospital and start asking questions. If you have no idea what to ask, just ask this one question and everyone will think you are a genius. The question? "Why?" Why are we doing this? Why haven't you checked this? Why are the costs so high? Why? Why? Why?

Surgery centers: Wipe that smirk off your face. Look around. There are eye centers, GI centers, ortho, ENT, spine, plastic, yada, yada, yada! If I had the resources, I would roll up all the small for-profit surgery centers in AnyTown, USA, into one large center. I would eliminate all the passive investors, make ownership in the centers meaningful to the surgeons, and make them rock and roll! All these mom-and-pop surgery centers only fragment the population, and most just eke out a living or are not profitable at all. (Yes, I know your center is wonderful and profitable and not at all like those I am writing about.)

It drives me crazy to audit a small ASC that is doing everything right, but just doesn't have enough cases to justify its existence. But if you took two of those centers and combined them. . . . Oh, what potential! (Too much ego for most to overcome, but it makes for a nice dream.)

With health care reform lumbering down the road, something is going to change. Reimbursement is going to go down. Surgeon fees are going to be reduced. The quality of care is going to be affected. What a wonderful opportunity to do something right! (Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: Web: Tweet address: Earnhart_EAI.)