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5 Challenges Facing Ambulatory Surgery Center Administrators

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Here are five challenges facing surgery center administrators in the next year, according to three administrators from very different parts of the country -- Boston, Oklahoma and Arizona.

1. Decrease in overall volume. Greg DeConcilis, administrator of Boston Outpatient Surgery Suites, says one of the major issues for his surgery center in the last few years has been a decrease in overall volume. "It's kind of uniform —even the busier surgeons are slower to some extent," he says. "The average physician just isn't getting as many people through the door."

He says this seems to result from several factors: high deductibles, high co-pays, and inability of patients to miss work. He says his surgery center has supported physicians in holding open houses and has tried to add several specialties in order to increase case volume over the next year.

2. Difficulty of recruiting physicians. Mr. DeConcilis says recruitment is also difficult, as hospitals continue to push physician employment and markets become more saturated. "In an area like ours, if they're not associated with a surgery center already, we're dealing with hospitals trying to employ them," he says. "We want to go and get someone to bring in more surgeries, but a lot of them are tied up."

He says he has successfully recruited physicians through existing surgeons at the center — both owners and non-owners. He first talks to the physicians to see if they know anyone who would be interested in bringing cases. "Next I go to anesthesia," he says. "Anesthesiologists work at different facilities and can talk to other doctors about the efficiencies of the ASC." He says the same is true for per-diem staff who work at other facilities and may know of physicians looking for an opening.

3. The disappearance of out-of-network. Mr. DeConcilis says his surgery center has also seen payors targeting physicians who take or refer cases to out-of-network facilities. His surgery center is less than 10 percent out-of-network, but his physicians have still seen backlash from insurers. "We have to be tighter on the cost side," he says. "It's crucial to have staff educated on preference cards and not opening supplies, because reimbursement is lower when you're in-network."

4. Physicians taking cases outside the ASC. If your physicians have a good relationship with the local hospital, you may see cases disappearing from your ASC. This is especially likely if your physicians' offices are close to the hospital, or they have a packed day of cases at the hospital.

"Sometimes there's an acuity level that means the physician must take the case to the hospital," says Chris Bockelman, administrator of Foundation Surgery Center of Oklahoma. "But because they want to maintain that hospital block time, they end up taking more than just their high-acuity cases there."

He says it's important to discuss with physicians which cases are appropriate for the ASC and which should be taken to the hospital. If you need to rearrange block times to provide dedicated days for high-volume physicians, you should take the initiative to do that.

5. Physical constraints and the need for expansion.
One of the most common mistakes in building a surgery center is failing to plan for future expansion, surgery center experts say. As surgery centers add procedures, specialties and physicians to bolster case volume in the face of declining reimbursement, many facilities will need to add ORs or even change buildings to accommodate changes.

Stuart Katz, administrator of TMC Orthopaedic Outpatient Surgery, is moving his facility into a brand-new tower building being constructed by the hospital — a move that will allow the facility to combine outpatient and inpatient surgery on the same floor. "This will allow the sharing of staff, instruments, equipments and supplies," he says. "It will also allow physicians to be more efficient and make better use of rooms, as the doctors can interspace arthroscopies between some total joints." He says the move will also allow more time on the schedule for physicians to add urgent and emergent cases.

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