Same-Day Surgery Manager: Ensure your program succeeds in tough times

By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates

There was a kinder time in the world. Nations were relatively at peace, and the future held nothing but blue skies and harmony. While our own industry is as stable as any, changes in reimbursement, shifting of physician loyalties, and profit compression have changed the way we operate our facilities. Or they should.

The fact is that most managers are not responding to these changes. Back when we were flush with profits and increasing growth of cases, it was easy for managers to let little things slide, such as increased tardiness by staff, cases starting later than normal, margins slipping but still very good, and the overall discipline of sound business models deteriorating.

Well, it is time to wake up and realize that times are tougher indeed than they were in the past. We are losing market share as corporate chains struggle to increase their earnings and develop new facilities. More than ever, our surgeons are faced with more options of where to perform their cases. Loyalties are become blurred as new deals are presented to them.

There is confusion in the reimbursement area as well, with news of equalizing payments between hospitals and ambulatory surgery centers (ASCs). Is this good for ASCs, or is it good for hospitals? Conversely, it is bad for hospitals, or bad for ASCs. It is all getting a little out of control.

So how do we respond? I certainly did not coin the phase, but it makes more sense now than ever: "When the going gets tough, the tough get going." This is a time for leadership. It’s a time when our staff and physicians are going to be looking for stability in an unstable time.

We need to increase the frequency of staff meetings and tighten up the discipline of the facility. This is not the time to be lax or turn away from issues that need to be handled. Let your department and staff know that it is business as usual and that while we cannot do much about external forces, we can make sure that our house is in order. Most staff members need clear direction and boundaries defined if you want to achieve optimal productivity. Now is the time to redefine those lines. Focus on the basics: marketing to the physicians, maximizing time efficiencies, and decreasing costs.

When was the last time you invited one or two surgeons to your staff meetings and asked for their input? As a firm, we interview thousands of surgeons, and overwhelmingly, they respond negatively when we ask them, "When was the last time the surgical staff asked you to assist them in reducing costs?" They are typically quite upset that no one has asked.

I have said it too many times, but you have to post your expectations of efficiencies. Staff need to know what your goals are. You cannot just talk about it. You must prove that you are serious and that there are repercussions if goals are not met.

Those departments and centers that are not profitable today will be less profitable in the months and years to come without a dramatic change in direction. Reduction in personnel must accompany reduction in procedures. Even with the difficulty of finding good staff today, you should not hoard staff who are unproductive or unnecessary.

On the brighter side, those centers that are doing well should expect to do better. Surgery is up all over the country. Baby boomers are having more surgery, and it is time to reach out and get some of it.

While it may be tough to be a manager these days, it is not difficult to attract new patients. The best way is to attract new surgeons! It is so rare that you will be approached by them; you need to seek them out. Ask your current users to identify those whom you should approach.

Redo your block schedule if necessary to make more time available. Expand your block to those who need it. A huge complaint we get from surgeons is that they could do more surgery if they could expand their block. Get your OR committee behind you to revamp your block requirements.

We will all weather this storm, but the strong will get stronger indeed, and the weak eventually will fall away unless they take action.

(Editor’s note: Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: searnhart@earnhart. com. Web: