Four Ways to Plan for ASC Success

By Kirk Jiannacopoulos, MBA

Across the nation, physicians and hospitals are increasingly adopting ambulatory surgery centers (ASC) as their preferred delivery model for outpatient surgery. Physicians increase control over their schedule, improve patient care and preserve or potentially increase income. Hospitals free up their operating rooms (ORs) for inpatient procedures and strengthen ties with key physicians. And most importantly, patients gain more accessible, affordable care in a welcoming, convenient setting. Developing an ASC can be a time-intensive process requiring thorough coordination and organization. Here are four ways to get a handle on the process — and increase your ASC’s chances for success.

Who should participate? Should it be single-or multi-specialty? What are your goals for your ASC? What about the ownership structure? What are the potential risks and costs, as well as the potential revenues? Answering these questions and clarifying the project vision is the responsibility of the initial project management team, which generally includes:

• Representatives from each physician group
• Representatives from hospital or healthcare group partners
• ASC business consultant to analyze financial feasibility
• Legal and financial experts to structure ownership and funding
• ASC architect/planner to develop site, design and cost estimates
• If needed, certificate of need (CON) consultant to direct CON submittals

The team should ensure proposed services fit marketplace realities. “An ASC is not just an extension of the physicians’ practice. It’s a business,” says Ron Samuelian, CEO of physician-owned Northwest Florida Surgery Center in Panama City, Fla. “You have to look at the specialties you want to offer in light of national trends and the dynamics of your area.”

Fleet McClamrock, administrator of the multi-specialty Palmetto Surgery Center in Columbia, S.C., adds that it’s essential to evaluate each specialty’s market viability. “If the types of surgery you can do change, a whole group of cases becomes obsolete, and there goes your patient load,” he says.

An ASC business consultant can help you run caseload scenarios. A typical ASC needs about 1,200 cases per OR per year, to succeed financially (with “cases” being the number of patients served, not the number of procedures performed). Thus, a two-OR ASC needs to attract about 2,400 cases.

The ASC consultant can also work with you and your legal advisers to address ASC ownership structure and syndication, determining what’s best for your business. Options include physician ownership and partnerships with hospitals, national firms and outside investors. In some instances the ASC consultant is offered a minority share as a performance incentive.

As your project goes “live,” you’ll likely add the following personnel to your team:

• Architect, engineers and construction representatives
• Imaging consultant
• Equipment specialists
• Municipal and state representatives for permits and inspection
• Financial institution representatives
• Staffing representative

This team faces decisions on everything from where to build to where to store clean linens. Roger Herritz, senior project director with Marshall Erdman & Associates in Madison, Wis., says a comprehensive work plan keeps the big decisions on track. “With increasing regulation, ASC development has become a scripted, lengthy, onerous process,” he says. “Your work plan should detail milestones to ensure everyone knows what has to be done, who’s doing it, and when it should be completed.” Herritz adds, “Be sure to build in realistic time for specific activities after the facility is constructed. You will need to plan for recruiting and training staff, as well as for inspections and certification for Medicare reimbursements.”

Good design brings you the efficiency and flexibility to improve both patient care and financial performance. Your ASC’s design should:

• Streamline patient and staff flow. Angie Kachevas, practice administrator for Gastroenterology Consultants, S.C. in Moline, Ill., says her group recently doubled the size of its facility with an 18,000-squarefoot addition. “Our main design concern was to give patients easy access and make it convenient for physicians to travel between their office spaces and the clinic.” Effective design also promotes staff efficiency, minimizing steps and interruptions. And it should separate incoming and outgoing patients. “You don’t want people in the waiting room sitting in fear as they see patients groggy from medication or leaning on crutches,” Kachevas says. She recommends creating separate patient waiting rooms and drop-off and pick-up areas to ensure convenience and privacy.
• Incorporate OR innovations. Today’s ORs increasingly feature imaging equipment and computers, requiring appropriate electrical and network connections. Innovations like ceiling-mounted boom assemblies add convenience and save space by assembling medical gasses, electrical video and data connections into a central location.
• Use space flexibly. Says Marshall Erdman design architect Brad Kramer, AIA, “In a typical ASC, the natural cycle is to have pre-op bays load up early in the day and post-op bays fill later on.” Where it’s feasible and codes permit, consider designing interchangeable bays for maximum flexibility.
• Anticipate special needs. Says Kachevas, “Because of our specialty, endoscopy, the number and location of bathrooms was important.”
• Prepare for tomorrow. Make sure your facility can expand without disrupting operation. “We left about 2,000 square feet shelled, just dry-walled,” Kachevas says. “As we grow we can add exam rooms, or procedure rooms and recovery bays.” ASC design should also easily adapt to changing technology. Plan your current facility to accommodate expansion that will not disrupt your current business, including the design of mechanical, plumbing and electrical systems. Kramer notes that it’s smart to include your ASC director in the design phase. “We’ve seen groups start with a consultant and later hire someone who wants to change the layout or the flow,” he says. Hiring a director early on avoids costly redesign.

Developing, designing and constructing an ASC demands that numerous people work together to make multiple decisions over a lengthy process. Take an organized approach, setting a clear strategy, doing a thorough analysis, and designing for today with an eye toward tomorrow, and your project will move from one milestone to the next, on the way to success.

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