One day a week means profits for some programs

Efficient use of resources, lower staff costs help

An efficient use of resources can lead to a profitable same-day surgery program, and one way to be efficient is to make sure that your OR staff move from one case to the next with no or little down time. For at least one same-day surgery center, this efficiency means being open for surgery only four to six days per month.

"Our center in Dedham, MA, does 25 to 35 surgical cases and five to 15 laser cases on the one day per week that it is open. If this center was open four or five days per week, profits would be reduced by 60%," says Brent Lambert, MD, chief executive officer of Ambulatory Surgical Centers of America (ASCOA) in Norwell, MA.

The other four days of the week, the only staff working are two administrative workers who handle scheduling, billing, claims, purchasing, and other record-keeping duties, Lambert says. Because salaries are often the highest or one of the highest expenses for a same-day surgery program, having the OR staff work only on a day that they will be busy is a good way to manage costs, he says.

Although there are fixed costs such as rent and equipment expenses that are spread over fewer procedures, these costs do not reduce the profit margin significantly, says Lambert. "We build very functional facilities without a lot of extravagant furnishings or excess space so we keep facility costs down to begin with," he says. These costs are not as high as personnel costs, which are managed by making sure staff are productive when they are at work, he adds.

John Dunne, CRNA, is administrator of the Cataract and Laser Center in Dedham, MA, which is one of the five New England surgery centers that Dunne manages for ASCOA. "I’ve managed and worked at surgery centers that were open four and five days per week, but most of the centers I now manage for ASCOA are open no more than five to 10 days per month," he says.

Dunne has no trouble finding staff to work in surgery programs that only open one to two days per week because he negotiates an hourly rate that is equal to or better than the rate offered by local hospitals. "Although we usually work 10 hours on the days we are open, I guarantee a nine-hour workday," he says. "This lets the employees know that they won’t come to work, then be sent home without pay a few hours later because we are slow. It makes it easier for them to plan their personal budgets."

There is no guarantee of number of days per month made to employees, but Dunne points out, "We try to look weeks or months ahead at our schedule. If we know one of our surgeons will not be busy one month because of a planned vacation, we’ll cut a surgery day as far in advance as possible so the staff members know how to plan their time."

In the same way, if Dunne sees a need for an extra day of surgery for a month, he adds it as far in advance as possible. In addition to the comparable hourly rate of pay, employees also like knowing that they won’t have to be on call or work weekends, says Dunne. "We usually have a lot of new mothers working for us or people who are trying to earn some extra money for things like college for their children," he explains. "The key to a good staff for this type of surgery center is to hire savvy people who understand that we are not an assembly-line facility but are a very busy surgery center one day a week."

There are generally five or six RNs, three surgical techs, and two office employees, says Dunne. Health insurance, sick leave, and paid vacation are offered only to the office personnel who work each day of the week, he adds. A contract for anesthesia services with an anesthesiology group provides an anesthesiologist and one or two certified registered nurse anesthetists on the day of surgery, says Dunne.

The cost of building and equipping a center that will only be open a few days each month is the same as a center that is open a full week, says Lambert. "We design it and equip it to handle a full day of continuous surgery," he says. For the Dedham center, this design means two ORs and one laser room equipped for ophthalmic procedures, he adds.

Because the Dedham center is owned completely by the surgeons who operate there, the state considers it to be an extension of their offices by says Dunne. This enabled them to open without undergoing any certificate of need approval, which would require that they demonstrate a significant need for additional surgery facilities in the geographic area, he says.

Patients are not concerned that the center is open only one day per week, says Dunne. "Their doctors tell them they perform surgery on Tuesdays and when they show up, they see a busy, efficient, pleasant surgery center," he says. In fact, he says, "At the end of the day, patients tell us how much they appreciate the pleasant surroundings, friendly staff, and short amount of time they had to spend in the center. That is another by-product of efficiency and good planning."

Sources

For more information about programs that are open a few days per month, contact:

John Dunne, CRNA, Administrator, Cataract and Laser Center, 333 Elm St., Dedham, MA 02026. Telephone: (508) 878-4977.

Brent W. Lambert, MD, Chief Executive Officer, Ambulatory Surgical Centers of America, 15 Farrar Farm Road, Suite Two, Norwell, MA 02061. Telephone: (781) 659-0422. Fax: (781) 659-0434. E-mail: blambert@ascoa.com.